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DS-16-1861 ('Cp Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-262504 Permit Number: DS-7-16-1861 Scheduled Inspection Date: December 05, 2016 Permit Type: Driveways/Sidewalks/Slabs Inspector: Naranjo, Ismael Inspection Type: Foundation Owner: POLLEY, RUTH Work Classification: Addition/Alteration Job Address:935 NE 95 Street Miami Shores, FL 33138- Phone Number Parcel Number 1132060143110 Project: <NONE> Contractor: G.E POOLS CONSTRUCTION INC Phone: (786)355-3382 Building Department Comments REPLACE EXISTING BRICK PAVERS ON SAND FOR Infractio Passed comments NEW PAVERS ON SAND INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid December 02,2016 For Inspections please call: (305)762-4949 Page 7 of 42 ` Permr '1UC3 Miami Shores Village rY?1lE TYI �Ir ew4yslSide stS[abs N.E. nd Avenue NE r WorkClassr�rca# 10050 ir1 �s�lti�i��tteratiQn t Miami Shores,FL 33138-0000 �'� ' t Phone: (305)795-2204 � D FC RtOP' due :7t1j3/2p1 ', Expiration: 1814/2017 Project Address Parcel Number Applicant 935 NE 95 Street 1132060143110 Miami Shores, FL 33138- Block: Lot: RUTH POLLEY Owner Information Address Phone Cell RUTH POLLEY 935 NE 95 Street MIAMI SHORES FL 33138-2517 Contractor(s) Phone Cell Phone Valuation: $ 3,500.00 G.E POOLS CONSTRUCTION INC (786)355-3382 Total Sq Feet: 600 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Foundation Type of Work:REPLACE EXISTING BRICK PAVERS ON c Additional Info: Review Planning Bond Return: Classification:Residential Review Building �JE Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due Bond Type-Owners Bond $500.00 Invoice# DS-7-16-60445 CCF $2.40 07/05/2016 Cash $50.00 $594.40 DBPR Fee $2.00 DCA Fee $2.00 07/18/2016 Check#:1425 $594.40 $0.00 Education Surcharge $0.80 Bond#:3148 Permit Fee $125.00 Scanning Fee $9.00 Technology Fee $3.20 Total: $644.40 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 constructi and zoning. Futhermore,I authorize the above-named contractor to do the work stated. , � July 18,2016 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy July 18,2016 1 Miami Shores e Villa g Building Department T 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 )UL 1G9 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 — FBC20B4 � BUILDING Master Permit No. PERMIT APPLICATION Sub Permit No. � BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 5 ft City: Miami Shores County: Miami Dade Zip: 33 3,y Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): 'RUA �(� )''Fs-1 Phone#: Address: 3 NO 9-5 --J r City: " 1 Y)m I State: � Zip: 3 3 1 3 6 Tenant/Lessee Name: Phone#: Email: /� 1 � CONTRACTOR: G� Company Name: Iyo L5 (o 9 s- Yrya7U►'� laic Phone#: 7ai to 3 i S3-5,?Z— Address: Z20 .Sc J 9 -7 `ISL- - City: H, '01M l State: Zip: 3 3 /6> Qualifier Name: cD i ) eYMo EsC2 u iJ4:C• Phone#: -796 .355 33 k0- State Certification or Registration#: Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 3 5 b0 Square/Linear Footage of Work: C,06 Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition Description of Work: e i�1,✓�r X/S'/I �tlG �i?�P{�S 4�') SA�J� r) r /? litJ PR tp�5 Specify color of color thru tile: m� Submittal Fee$ � � Permit Fee CCF$ CO/CC$ Scanning Fee$ as Radon Fee$ � DBPR$ Notary$ Technology Fee$ o Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ �� v TOTAL FEE NOW DUE$ a /, (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 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. Signature c' P Signature OWNER sr GENT C TRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of 20 AP ,by � //J day of of 20 A0 by i�L n e who is personally known to (�,,i fffr '10 4 SQu i who is personally known to me or who has produce 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 Sigpty . ;oat% AIDA PEGUERO 4° •Po.c AIDA PEGUERO Print: Print: * SSIeN#FF Nsm Seal: �, t EXPOES.October 5,2018 Seal: Exi"IRES:Gciober 5,2018 9 OF� O 6ondeo inn,du1gN Notary Services ,�lEOF ROO Eonaea ThN lutlget Notary SlrvhES APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) s:i§tld. i,`i�..'u>. .•x:c`�.`4..;t''s�}'�d .•cam:. .a�i {y�,; COUNTY-WIDE LAND SURVEYORS INC. LAND SURVEYORS PLANNERS _�' 1. P.O. BOX 823271 SOUTH FLORIDA, FL. 33082-3271 (305) 772-0766 iSC�Q ',:°: .;`'."6 ., :+' •• , / 00 't5. .'• ••;,:+,•{i� �:•i� •ito, .a., i1,4 A. 17irp /rG vialto 13 LEGAL E i5. ysiA BvJc �0°Zyr G L D SCRIPTION T.: ,'' � �':a� .:, ';`..•: Lot 20 and 21 in Block 76 of MIAMI SHORES Z0CA-11olj 5icE-7eNI /VoSCALO SECTION NO. 3, according to the plat thereof, Pow- as recorded in Plat Book 10 at' Page 37 of the P EQUIP. Public Records of Miami-Dade County, Florida. - - p`�`'� N �' Lvo F.cEd 33�4 0. SURVEYORS NOTES: �j JUL 052o16 A&Vil3 Ate xI'�Z" Z Spotty. 1 ) . Legal description provided by client. - ---- , :. s 4 v 2) . Only record plat easements are shown. 3) . Right of way. information obtained from record plat. 7-7' � v 4) . IN Federal Flood Zone X, Pane1, 0306 last revised 9-11-2009. ¢ Ate OM 5) . Benchmark used-Dade County BM# B-62 Elev. 8.65 ' NGVD1929. I Coad 6) . Elevations are referenced to National Geodetic Vertical Datum 1929 ti—S�✓ Jz•77 Adjustment (NGVD1929) . 3s-mss � 7 _ b ,5 Q � lS-joey Cas Ra• dt I3S ..• a� 17.70. osis• • • ls• •3 •• ' V R •9900:• • • _ sg•os. > < N /Z•7d •seg• • • i • i ''- � � � W � O,taR !�• . •• • cgs••• 0=1 '! �i LU U • •• •• CO -� C�uuMv ages• • •• �S,-0'Z-' �-s•g�• • • • • • Cn rc '� e••se •e• • ss•••• •gg•g •.•• goes• ` E EL z eggs �•so 1 , •s•of •gags• -- j r s s' • p WVase M s • • s i*a 060 rj PtPEGD• PtPrCIO BOUNDARY & IMPROVEMENTS SURVEY < - - .5' G P/Je, WIC. E1 'A7 Ae �El! FOR: Ruth Polley 935 N.E. 95 St. Miami Shores F1 3 � � � CERTIFICAT9 NO NOT VALID UNLESS SEALED WITH AN EMBOSSED SURVEYORS SEAL." ZZ�!lRASS I HEREBY CERTI THAT THE SURVEY REPRESENTED HEREON COMPLIES WITH THE ASPM• . MINIMUM TECNNI L, STANDARDS ADOPTED BY THE FLORIDA BOARD OF SURVEYORS AND � MAPPERS IN CHA ER 610 17-6, FLORIDA ADMINISTRATIVE CODE, PURSURANT TO SECTION 972,02 Florida Statutes. � � REVISIONS BY IDATE URDA-16 Svegf 7-31-zoo, l�iM� JOSEPH L. MARTIN PROFESSIONAL LAND SURVEYOR *4368 DRAWNBY SCALE DATE F.B./PG. J013 40 t�tt2 /V,e 9S S% STATE OF FLORIDA �LM )��'ZO' 3-3-Zott Tort- 00 DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 07/05/2016 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 NAME: HEYDE SOTOLONGO Sunset Property and Casualty a/coNNo Ext): (305)270-1447 ac No: (305)273-1237 9360 Sunset Drive Ste 257 E-MAIL @ ADDRESS: otto@sp-insurance.com s cinsurance.com INSURERS AFFORDING COVERAGE NAIC# Miami,FL 33165 INSURERA: NORMANDY INSURANCE COMPANY INSURED INSURER B G.E.POOLS CONSTRUCTION INC INSURERC: 4220 SW 97 PLACE INSURER D: INSURER E: MIAMI FL 33165 INSURERF: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR I D POLICY NUMBER MM/DD/YYYY MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE El OCCUR PREM ES(RENTED PREMISES Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PRO JECT F-1LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTYDAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONX STATUTE EORH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000.00 A OFFICERIMEMBER EXCLUDED? ❑N N/A NHFL0048772016 02/12/2016 02/12/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached I more space Is required) SWIMMING POOL CONSTRUCTION,INSTALLATION,OR REPAIR 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 BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ND AVENUE AUTHORIZED REPRESENTATIVE ".- MIAMI SHORES FL 33138 �' ' ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD