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BPP-16-198 (2)
Miami Shores Village a 10050 N.E.2nd Avenue NES ! _ Miami Shores,FL 33138-0000 Phone: (305)795-2204 frr Expiration 08117/2016 Project Address Parcel Number Applicant 164 NE 106 Street 1121360130660 Miami Shores, FL 33138-2033 Block: Lot: GLENN FORD CATHERINE HABI Owner Information Address Phone Cell GLENN FORD CATHERINE 164 NE 105 Street -------- - MIAMI SHORES FL 33138- 164 NE 105 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone STAR-LITE POOLS (954)747-3377 Valuation: $ 26,275.00 Total Sq Feet: 416 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Pool Deck Date Denied: Wall Steel Type of Work:Swimming Pool Occupancy:Private Fence Additional Info:RENEWAL OF EXPIRED PERMIT BPP14- Bond Retum: Final Classification:Residential Scanning:1 Review Plumbing Review Planning Review Electrical Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $16.20 DBPR Fee InVO1Ce# BPP-1-16.58441 $11.82 01126/2016 Check#:25406 $50.00 $808.09 DCA Fee $11,82 Education Surcharge $5.40 02/19/2016 Check*26101 $808.09 $0.00 Permit Fee $788.25 Scanning Fee $3.00 Technology Fee $21.60 Total: $858.09 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 zoni Fu ermor ,I auth rite the above-named contractor to do the work stated. February 19,2016 Authorized Si ature:Owner / Applicant / Contractor / Agent Date Building Department Copy February 19,2016 1 i i Miami ShorE S VHIl ge Building De artment " Z�s tots 10050 N.E.2nd Avenue,Miami Shores,Florid 0 33138 BY. � Tel:(305)795-2204 Fax: 305)756-8972 INSPECTION UNE PHONE NUN BER:(305)762-4949 FBCi 20 t BUILDING Master Permit IVo.9/ PERMIT APPLICATION sub Permit NO. BUILDING ❑ELECTRIC ❑ ROOFING ❑ RE ASION ❑ EXTENSION ®RENEWAL ❑PLUMBING ❑MECHANICAL ❑PUBLIC WORKS ❑ CH hNGE OF ❑CANCELLATION f❑SHOP COTRACTOR DRAWINGS JOBADDRESS: 164 NE 105 Street Miami o unty: Miami Dade Z' Foltoipa ;11-2136-013-0660Is the ilding Historkally Designated:Yes _NO X Occupancy Type: Res Load: Construction Type: New Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):GLEN FORD&CATHERINE HABERMA14 Phone#:305-.05-7104 Address:164 NE 105 STREET city; MIAMI SHORES State: FL Zlp; 3138 Tenant/Lessee Name: N/A Phone#: Email: GLEN.FORDQBTINTERNET.COM CONTRACTOR:Company Name: STAR-LITE POOL BUILDER Phone#: 954-: 47-3377 Address: 10875 NW 52 STREET#8 city. SUNRISE state: FL Zip: 3 351 Quallfier"Name: MICHAEL BIXLER ! ph ;954- 47-3377 State Certification or Registration#: CPC14458513 Certificate of[Competency#: DESIGNER:Architect/Engineer: DAVID FAERMAN Phone#:5-1787 Address:22171 WATERSIDE DRIVE may, BOCA RATON State: FL Zip; 33428 Value of Work for this Permit:$ _ 2- __,QA Squa Unear Fool ge of Work: Type of Work: ® Addition ❑ Alteraticln ❑ New ❑ ROpair/Replace Demolition Description of Work: , CLOSE PERMIT Int N - 26671- Specify color of color thru tile: Submittal Fee$ c�O Permit Fee$ U cS CCF$ Scanning Fee$ -S Radon Fee$ ` DBPR$-LI. Notary 4 Technology Fee$ f Training/Education Fee$ cue ® Double Fee$ Structural Reviews$ ^ Bond$ - 6 TOTAL FEE NOW DUE$ txeMeedoa/24/2014) - ti 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 a d a reinspection fee will be charged. Signature Signature _//,�� OWNER or AGENT ANTRACTOR The foregoin instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 22 day of JANUARY 12016 ,by 22 day of JANUARY 2016 •by GLENN FORD ,who is personally known to MICHAEL BIXLER •who is personally known to 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. NOT!LE UC: NOTARY PUBUC: Sign: Sign: L Print: A MASKE Print: DALE A MASKER Seal DALE MASKER Seal: ",","' DALE A.MASKER Commission#FF 236797 =� `;= Commission#FF 236797 *; - Expires June 6,2019 ' • w Expires June 6,2019 8m49d TWO Tm/Fad bwreroe 7019 win, N, a 8ondadTtwTroflFahtrouranoe •7018 ########### ## ########################################################################################### APPROVED BY XhtfLb Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 0 STATE 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 ST TE POOLS 733 SE 9TH AVE DEERFIELD BEACH FL 33441 CorigratuitionWl With this liiiense jrou-berdme onwof the nearly- one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA T from architects to yacht brokers,from boxers to barbeque restaurants, and they keep Florida's economy gong. DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Every day we work to improve the way we do business In order to CPC1468513 ISSUED: 06/29/2014 serve you better. For information about our services,please log onto wwwrmyfloridalicense.com. There you can find more Information about our divisions and the regulations that impact you,subscribe CERT COMMERICAL POOLISPA CONTR to department newsletters and lam more about the Department's BIXLER,MICHAEL D Initiatives. STAR-LITE POOLS Our mission at the Department Is:License Effidently,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.488 FS. and congratulations on your new licensel ExpWon date:AUG 31,2018 L14COMOIGM DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FL DA DEPARTMENT OF BUSINESS AND P1 1,10FESSIONAL REGULATION �. CONS. TRUCTION INDUSTRY ICENSING BOARD z CPC14M13 The COMMERCIAL POOIJSPA CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 BIXLER, MICHAEL D O• STAR-LITE POOLS • 10875 NW 52ND ST SUITE 8 SUNRISE FL 38351 R MOM • r;^ BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT ' 115 S.Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 3Q,2016 DBA: Receipt#:188-625 G=) STAR-LITE POOLS POOL/MARINE CONTRACTOR (CERJ Business game: Business Type: POOL/SPA CONTRACTOR) <5 "0 �.. " Owner Nine:MICHAEL P BIXLER Business O ened:10/03/1994 4 a Business Loc�tion:10875 NW 52 ST 8 p 1 State/County/Cert/Reg:C PC 14 5 8 513 Pa SUNRISE Exemption Code: Business Phone:954-747-3377 r; Rooms seats Employees Machines Professional 3 a For Vending Business Only y Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid �,. 27.00 L 0.00 0.00 0.00 0.00 0.00 29.70 mai �'.,. THIS R-CEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOM r S A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is s non-regulatory in nature. You must meet all County and/or Municipality planning WHEN VAUD.4TED and zoning requirements. This Business Tax Receipt must be transferred when i the business is sold, business name has changed or you have moved the 0 business location.This receipt does not indicate that the business is legal or that 11, it is in compliance with State or local laws and regulations. , Mailing Addr, •) MICHAEL i 'XLER Receipt #10B-14-00009654 y 10875 NW STREET #8 Paid 07/29/2015 29.70 SUNRISE, 33351 a 2015 - 2016 e STARL-1 OP ID:GJ CERTIFICATE OF LIABILITY INSURANCE DATE(MMODIYYYY) k.--- 1 09/10/2015 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 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 David R.Griffiths Insurance By Ken Brown,Inc. PHONE 321.387-3870 FAX No):321-387-3888 PO Box 948117 AIC No w Maitland,FL 32794-8117 David R.Griffiths INSU 8 AFFORDING COVERAGE NAIC 0 INSURERA:Amerisure Mutual ins.Co 23386 INSURED Star-Lite Pools INSURERB:Amerisure Ins Company 18488 Star-Lite Pool Builders Inc. INsupmc:Bridgefield 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. LTR TYPE OF INSURANCE WVD POLICY NUMBER DD EFF LI EXP LIMITS B X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,00 M I mu CLAIMS-MADE a OCCUR GL20788230401 09/1312015 09/13/2016 PREMISES Ea 0=ra oe $ 100,00 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 100,00 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY LE71 LOC PRODUCTS-COMPIOPAGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY OMBBIINEEDtt IN UMIT $ 1,000,00 B X ANY AUTO CA20569870701 08/13/2015 09/13/2016 BODILY INJURY(Per person) $ AALL UTOS OWNED SCHEDULEDBODILY INJURY(Per acddent) $ AUTOS XX NON-OWNED PR PERTY DAMA•E $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000, iR A EXCESS LIAR CLAIMS-MADE CU20032831303 09/13/2015 09/1312016 AGGREGATE $ 3,000,00 DED X RETENTION$ 0 $ WORKERS COMPENSATION X AND EMPLOYERS'LL46LL ITY STATUTE ER YI C ANY PROPRIETOR/PARTNER/EXECUTIVE ❑N N/A 18601875 06/2612015 06/26/2016 E.L.EACH ACCIDENT $ 100, OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE0$ 100,00 rc yyes desaibe to DESGtRIPTION OF PERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mawe space is required) License#:CPC1468513 CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g g ACCORDANCE WITH THE POLICY PROVISIONS. Department 10050 N.E.2nd Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD