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BPP-12-238Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 169873 Scheduled Inspection Date: March 28, 2012 Inspector: Rodriguez, Jorge Owner: VILLAGE, MIAMI SHORES Permit Number: BPP -2 -12 -238 Job Address: 10200 BISCAYNE Boulevard Miami Shores, FL Project: <NONE> Contractor: ESSIG POOLS INC Permit Type: Pools/Whirlpools /Hot Tubs Inspection Type: Final Work Classification: Repair Phone Number Parcel Number 1122310450010 Phone: 305 - 949 -0000 Building Department Comments EXISTING POOL RESURFACE Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. March 27, 2012 For Inspections please call: (305)762 -4949 Page 3 of 21 Owner's Name: MIAMI SHORES VILLAGE Owner's Phone: Job Address: 10200 BISCAYNE Boulevard Total Square Feet: 8098 1 Miami Shores, FL Total Job Valuation: $ 38,000.00 1 Planning and Zoning Criteria Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Folio Number:1122310450010 Contractor(s) ESSIG POOLS INC Phone 305 - 949 -0000 Primary Contractor Yes Planning and Zoning Criteria and Comments Approved: Yes Comments: Date Approved: 2/9/2012 : Yes Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING Permit No. &t 2— 9‹..% PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: BUILDING EMSIV- OWNER: Name (Fee Simple Titleholder): a" IA 444 5 444e J A'GC Phone #: S- q -4.902. Address: 100 SO 4%1 d 1-101) .4ij4 City: 1aw+1,F5 State: Zip: Zi ' ; apt '5 8 Tenant/Lessee 14e: Phone #: Email: It JOB ADDRESS: 9 � o �I A•N► $ CAC �L h- ttic., �' 15C /411 8- h -\ilD L �A EA To 5�6-t-Yi t ' City: Miami Shores County: Miami Dade Zip: ,351 3 E" Folio/Parcel #: '1 1 2.23 1 045 c 1 Is the Building Historically Designated: Yes NO X Flood Zone: CONTRACTOR: Company Name: p e-eL Hu( Phone #: -4 0 r- 9 " Coco Address: J efe+O W 1S1 ST• City: jot/ • " A.4401 State: k.'C - Zip: 3 5/ ( Qualifier Name: 04 SC1 & Phone #: a i ey 9 m r'0 State Certification or Registration #: Certificate of Competency #: ceco Y 1S i Contact Phone#: 3 r( y DCW Email Address: 2w1 i TS S5 >1g DESIGNER: Architect/Engineer: N fry Phone #: Value of Work for this Permit: $ Square/Linear Foo , ge of Work: Type of Work: ❑Addition ❑Alteration ❑New %" epair/Replace ❑Demolition Description of Work: 4:501-A--;Acs- .0 al G., (� ;- o X10 R; *> > i:********* *u:*********>f:ax***** ***** **4 es**k * **** :***** u**** *******>k>k *a:**** *>i<*>r.** * *x *** Submittal Fee $ Permit Fee $ � CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 val promise in good faith that a copy of the notice of commencement and construction lien 1 whose property is subject to attachment. Also, a certified copy of the recorded notice for the first inspection which occurs seven (7) days after the building permit is inspection will not be approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of �:A ,20 , by 100A lfiAfGVI wh is personally kno me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: A 6A0 a. .;d,6,/ • MY COMMISSION ADD 955300 _,vi EXPIRES; March 29, 2014 Bonded Thru Notary Public Underwriters eeding $2500, the applicant must • be delivered to the person posted at the job site f such posted notice, the The foregoing instrument wa . o edg ,. before me this' 2---' day of -L o , 20 12, by �vz�1 � . who is personally known to me or who has produced as identific..r'on and NO LIC: e an oath. Sign: Print: My Co �1 ` 1 11 !L A, D904411 SEP. 27, 2013 CBONDING CO., INC. Z **de***% k***** *xY*#************* **** k ***************tk ******** f***** *******r ',t*** ************** *U!a:***' R �k�k�k�k�k***** APPROVED BY Plans Examiner � � � / Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk MIAMI -DARE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, >FL ^33130 2011 LOCAL BUSINESS TAX RECEIPT 2012 MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2012 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 &' 10 THIS IS NOT A BILL — DO NOT PAY 192799 -6 RENEWAL RECEIPT NO. 203516-0 STATE# CPC052505 BUSINESS NAME / LOCATION ESSIG POOLS INC 1800 NE 151 ST 33181 NORTH MIAMI OWNER ESSIG POOLS INC Sec. Type of Business 196 SPECIALTY BUILDING THIS IS ONLY A LOCAL BUSINESS TAX RECEIPT. IT DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES, NOR DOES R EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR UCENSE REQUIRED BY LAW. THIS Is NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- TIONS. PAYMENT RECEIVED MIAMI-DADE COUNTY TAX COLLECTOR: 07/13/2011 09010059001 000045.00 SEE OTHER SIDE FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 WORKER /S CONTRACTOR 10 DO NOT FORWARD ESSIG POOLS INC 1800 NE 151 ST NORTH MIAMI FL 33181 6 AC# . , lir'"T'VP • • Bti xlig q ,CrriPelreteCrri e;iii per „ .1)1 did:7 alia-1. 14- • • • • P.'2! • • • - • - ' - ' (t■ 0 11/4;01,1:001,0 49'S.1.6a.9'69;90 'CFC051;505 MNIEROAIOledOTA/SOXXOWRAPTOlt,:',.:___ • eilmil::6,,,P,ittptittiottbix erSiii'PE6WrItell'ons siitir.th4at.4419'4,Y4 Expiration date: AUG 31, 2012i.!,.:.::,-i-.7444-,--7- ■■ . .,,,.,,.,... -- 4,1v, ,. I ,.,. ... --'- Vb.8 IIb 4f, : To ;AO SS:, - la411 tt ES'S 1G4'!' POOLS INC . 18.00 NE. STREET • ' ' 'I' ''?. -Or. ;,,,;v 1, ,'.1" - - -- NORTH MIAMI FL 33162 .„ ' ''. I! ■ •.‘ ;.v - • :;■;if:'. 1'0,7;111, 111 , 1,1'„1■I i4.1CHARliTg IST „ • 1 CHARLIE 1.,GOVZ .. - gtc-RET.AAT1.,, "o'- 'DISPLAY A814EOUIRED,713Y LAW: 1 A 3 D CERTIFICATE OF LIABILITY INSURANCE OP ID AI DATE(MM/DD/YYYY) 11/30/11 1 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 BROWN & BROWN OF FLORIDA INC 14900 NW 79th Court Suite #200 Miami Lakes FL 33016 -5869 Phone:305- 364 -7800 Fax:305 -714 -4401 (.UN I AI.I NAME: (NCNNo, Ext): (NC, No): AAAD ADDRESS: PRODUCEER Rio#: ESSIG -3 INSURER(S) AFFORDING COVERAGE NNC# INSURED Essig Pools, Inc. 1800 NE 151 Street Miami FL 33162 -6010 INSURERA: Valley Forge Insurance Co. 20508 INSURERS 4026403362 INSURERC: INSURER D : $1,000,000 INSURER E : PREMISES(Ea occurrence) INSURER F : 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 W HICH 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 POUCIES. LIMITS SHOWN MAY RAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AUD- INSR SUBb WVD POLICY NUMBER POIDDYEFF (MMIDD/YYYY) POLICY YYY (MM/DD/YYYI) LIMITS A GENERAL - LIABILITY COMMERCIAL GENERAL UABILITY OCCUR 4026403362 12/01/1112/01/12 EACH OCCURRENCE $1,000,000 X PREMISES(Ea occurrence) $ 100,000 CLAIMS -MADE X MED EXP (Any one person) $10,000 PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE UMITAPPUUEESPER POLICY n JECT PRODUCTS - COMP/OP AGG $2,000,000 I BLOC F-1 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 4026403376 12/01/11 12/01/12 COMBINED SINGLE LIMIT $ 1,000,000 X YINnt) BODILY BODI INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ X $ $ UMBRELLA UAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKERSCOMPENSATION AND EMPLOYERS' UABILITY Y / N ANY O CEER/MEMBER EXC UDE ED EC � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 4026403331 12/01/11 12/01/12 X WCSTATU- X ..a_ TORY LIMITS ER E.L EACH ACCIDENT $1,000,000 E.L DISEASE - EA EMPLOYEE $ 1 , 000 , 000 E.L DISEASE - POLICY UMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) OLDER CANCELLATION MIA -138 Miami Shores Village 10050 NE 2nd Avenue Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2009 ACORp CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD