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FW-16-1199 Permit No. FW-5-16-1199 `yNones LMiami Shores Village Permit Type:Fence7Wall 10050 N.E.2nd Avenue NE r. � Work Classification:Wood Fence Miami Shores,FL 33138-0000 Per 'i t Permit Status:APPROVED Phone: (305)795-2204 FLORIM IssuIa Date:5110/2016 Expiration: 11/06/2016 Project Address Parcel Number Applicant 9740 NE 13 Avenue 1132050090450 Miami Shores, FL Block: Lot: JANICE MOST Owner Information Address Phone Cell �JALNICE MOST 9740 NE 13 AVE MIAMI FL 33138-2546 Contractor(s) Phone Cell Phone Valuation: $ 2,960.00 ULTRA FENCE INC (305)592-4578 Total Sq Feet: 128 Approved: Available Inspections: Comments: Inspection Type: Date Approved: : Final Date Denied: Foundation Type of Construction:Wood Fence Additional Info:WOOD FENCE 6'HIGH Review Planning Classification:Residential Scanning:3 Review Planning Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# FW-5-16-59637 DBPR Fee $2.00 DCA Fee $2.00 05/10/2016 Check#:2310 $45.80 $100.00 Education Surcharge $0.60 05/04/2016 Check#:2308 $ 100.00 $0.00 Permit Fee-Wire&Wood $128.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $145.80 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required forELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS-AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above-na d ntractor to do the work stated. May 10, 2016 Authorized Signature:Owner / Applicant / 6 Contractor / Agent Date Building Department Copy May 10, 2016 1 Miami Shores Village FgcravrisD tots Building Department AY o 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY 3 Tel:(305)795.2204 Fag:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 BUILDING Permit No. PERMIT APPLICATION Master Permit No.TSA (G ` I �'I FBC 20 Permit Type: BUILDING­ OWNER: "' OWNER:Name(Fee Simple Titleholder): 4 l 1C e- M(J,57 Phone#: Address•Q Z d Mve 1 " City:,W/i2 z"/ __�Zip: Tenant/Lessee Name: Phone#::5,4 Email ,, C G (� JOB ADDRESS. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Flood Zone: CONTRACTOR:Company Name: U Li no re r),ce L Phone#(2)E 9_2_1'__7 Address: -I Ot lJl7 �fp�A City: \--1 t `n J=,, State �� Zip:i ) ��— Qualifier Name: (--' 0ZC-1 n-) I fD Y`r e.S Phone#• State Certification or Registration#: Certificate of C\Tpetency#: I 1 Contact Phone#: Email Address: Q 2_C -C-O'•"e�L,'--45D DESIGNER:Architect/Engineer: Phone#: Value of Work for this Permit:$ c9 9L b C'Quare/Linear Footage of Work: Type of Work: DAddress OAlteratio ONew ['1L Repair/Replace ODemolition Description of Work! �� aLJI y c:_P_ C ti COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: ************//**��****«********••****r.****Fees***«*+r*****•******,►.t+r•**�+r,r«�**,►,r*�**,►**•«** Submittal Fee$ W Permit Fee$ 1 ZE3 r CA) CCF$ ( " 9D CO/CC$ Scanning Fee$ W Radon Fee$ a,w DBPR$ 2- -� Bond$ Notary$ Training/Education Fee$ O -60 Technology Fee$ Q :� Double Fee$ � Structural Review$ TOTAL FEE NOW DUE 04�3 F3- .,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 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 o the recorded notice of commencement must be pasted at the job site for the first inspection which occurs seven (7) s after the uilding permit is issued In the absence of such posted notice, the inspection ill not be approved and reinspectio a will be ch rged S ;::1), i a A4 t l G`� / Signature 8n Owner or gent Contractor The fo ing instrument was ac owledged before me this The foregoing instrument was acknowledged before me this day of day of `r— 20_by (.,.0 2 G+r 676 6 who o has produced who isp ss�e�e me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign Si "�V P�iA► ANA M TORRES Print: Print: Nomy Public-State o ora ,`� "�'•, M Commission Expi Commission#t FF 210912 My Commission �- Notary Public-State of FJ2019 My P Commission#�FF 210 My Comm.Expires Jul 7,2019 = My Comm.Expires Jul 7,,�� "`� Banded through National Notary Assn. '' °;;� •• Bqd�through National Nota ««««««««««««««««««««««««««« ««««« «« ««««««««««««««««««««««««««««««««««««« Zonin APPROVED BY Plans Examiner v g Structural Review Clerk (Revised 07/10/07XRevised 06/10/2009XRevised 3/15/09xrev6/4/10) ♦ R532s s� Miami shores Village 'dot@ Building Department ` 10050 N.E.2nd Avenue Miami Shores, Florida 33138 �OR1DA Tel: (305) 795.2204 Fax: (305) 756.8972 SURVEY AFFIDAVIT STATE OF(FLORIDA) COUNTY OF(DADE) The undersigned Affiant, L10 i CO-MQ ±PI cUddoes hereby attest that (Property owner) The attached survey,performed by� + ' ,\\ (Name of surveyor's company) For address: q--) `'I 0 Performed on LIZ II (date of survey)is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. esay th ugh �- d T r Signature Property Owner Print Name ND SUBS BED before me this 2.7day of�n ,` ANAMM TORRES Affiant is rsonally known to me, roduced * e tMllc-State of Florida • •= Commission#t FF 210912 ? My Comm.Expires Jul 7,2019_ its`�``d Borxled tlrouph Natlond Notary Assn. �-410U d Notary Revised on 5122/20091 Revised on 6/12/09 t L Ultra Fence Inc 7941 NW 64 ST MIAMI FL 331 166 CONTRACTOR WORK EXCEMPT AFFIDAVIT Sate of Fl County of Niami-Dade Before me this day personally appeared Lazaro Torres.who, being duty sworn,deposes and says: His workers compensation exempt form is attached for reference to pull out permit. Which expires 10/9/2016. That he will be the only person working pn the project located at . Sw m to (or awn ed) and subscribed before me this day O f ►-1l 201�,. ^•t t Personally Known —'_0 proauc`eaia ` Type of identification produced Print,type or stamp name of Notary 0 �•..•�'�"'�.,, ANA M 70a ES ` NotaryPublic-State of Florida •s Commission�i FF 210912 My Comm.Expires Jul 7,2019 ��� ° 4,',•�, Bonded through National Notary Assn SNoRFs G� Miami shores Village - NigroBuilding Department �l10050 N.E.2nd Avenue OR1Dp' Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: I - r Owner State of Florida County of Miami-Dade //���� The foregoing was acknowledge before me this day of (.�1, 20 By u(1 l�2 —1� 1�, I/'�'� w s personally know or has produced as identification. ANA M TORRES Notary: /Y l._� ,mss°* `�; Notary Public-State of Florida a :•, Commission#FF 210912 SEAL: �,; 11,�?;� My Comm.Expires Jul 1,2019 Bonded through National Notary Assn. Sep 141510:23a WILVER ALiMARALES 305-382-6777 i A "� CERTIFlC1TE OF L,t�4tLlTY INSURANCE .. . ... t........Q9l14y1§ PRODUCER WAM Insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER 0'r IRtF4R1NATI0D3 10637 SW 88th at.Ste 7-1 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Mi=4 FL 3317H HOLWA 7MS CERTIFICATE DOES Nor AMEND,EXTEND OR Phone(3)5)274.4353 0 T £AY FEdl��4� �P_0�1�'d>�$_ITELOW Fa,c (3 70 e9sa INSURERS AFFORDING COVERAGE MAIC 4 INSURED ULTRA FENCE INC. INSURER.A:,GRANADA INSURANCE COMPANY 7841 NW 64 STREETMiami,FL F:L 33186 !N§!?Rr lN_SUPIER a_.-•- •-_ i AVE - INSUER E: COVERAGES I_ RF.: . _ -. - . ----- - ---- ..­­ TWETHE _ E_ D TO THE INSURED NAMEDAMM FOR THE POLICY PQ2{OD tNDICATTE:D.-NOTWffNSTANbilia ANY REGUIREMEN'T,TERGA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENTVq TH RESpECI'TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PEITrAIV.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,OCCLUSIONS AND CONDI SS DF SUCH POLICIES AGGREGATE JMITS SItOWN h?!AY HAV&BEEN REDLICED BY PAID CWFUS. ' J TAWL YPE OF INSURANCE POLICY NUdI�R !'OLICY Erif G i11t8�PDkICY E�tPIA+�TiON a.7R 1C _. _ - bATEtC1UOQ-_ LBM+?olDl. GENERAL LUiBILI CY EACH OCCURRENCE 1'000 ow COM� RA RCIALt}ENEL UABILITY DAMAfsI:�'--� --' t. 0185FLOOD52545 09/t}6115 09108116 5{Eaoaamange) 100,000 I 1 CLfUIdSMADE OCCUR - - A MM EV(Anyone person) 5:,000 _ f'OOa,fl001 PERSONAL AADV 1tElURY I' GENERALAGGREGATE-I 2`OOD,OOD 113EN'LAGGREGATE UA$TAPPLiES PEWI pRODLICTS-COR6WOP AGG i 2'000,00 ,b POLICY ._I PROJECT 1:1 LOC _ -----_--- AUTONOWLEUA81LITY ]� ANY Avro 'COMBINED SINGLE LIMIT - - - (Ea adder) l 1 ALL OWNED AUTOS SCHEDULED AUTOS BODILY IN,tURY !� HIREDALrTO8 [_ 'NON omre0 AUTOS BODILY{INJURY • EPe<'actlCeru) _. - _._-.--__--- PROPERTYDAMAGE Per aocidenq ®ARAGE LU1�tCITY - vTO ONLY-EA ACCIDENT L..� J ANYAUTO ---.. TOTHER THAN FfACC - AUTO ONLY: AGG — EXCESSiUYBRELLAUAWARY F-AC14OCCURRE14CE - L, (-I OCCUR r i CLARASIANDE AGGREGATE -- U OEDUCMBtE ---- I_1 RETen= s VUORIEERS COIAP#Ii ildN EMPLOYERS'LIABILITY MAAIV-{ g ANY PROPRIETOR I R4M- ERf EIECUTNE i i=L EACH ACCIOESIi -_ OFFICER I MEMBER EXCLWEM I _It yes,dwAn*urger ., e E-L.DISEASE-EA>rAfPL©TEE DISEASE SPECIAL__PROVISKMIS bemw E.L. - LOAfr arlJi _ - - _ - - POLICY I DESCRPTN7N OF Ai7Wt8/LQCAZiON8 i St'ENtG,W tC?LGWS1pN,g ADD>ri7 HY ENDLIRSENENT E$PECiAL PROVISIONS -----`� i I Fence Installer i ,. ._. _. . RTIFlCATE HOLDER cAci LATION SRVULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ax"PRAT,ON DATE THEREOF THE 9MING INSURER WILL ENDEAVOR i0 mAIL 10 DAYS WRITTEN NOTICE TO TMCERTFRCATE HOLDER NAMED TO i ft Clik.BUT FARUR@ To 00 SO SHALL Itdp08E No OBLIGATION OR LIASILAY OF'A'VY KIND UPON THE IMS.ITS AGENT$OR REPRESENTATIVES. Village'&Miami Shores __..—•_—__-• ' AUTHaR[ZEQ REPR�ITATIVE Miami_Shores..F1NE 2 Ave 33138 �'vlL��ER ALMARALES ...._--_Mlami . �, • ---- - - •-••-. �.�- _ �AGtMD CtytPORA17QN 1988 I _.............. _ i . ' coo mn K m , . . �2 U^ IW M L T RA, CE c+t� UQARO ft "Wol ° ' JEFF ATWATER CHEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION *"CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION.INDUSTRY EXEMPTION This certifies that the individual listed bebw has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 10110/2014 EXPIRATION DATE: 10/9/2016 PERSON: TORRES BARO FEIN: 412215274 BUSINESS NAME AND ADDRESS: ULTRA FENCE INC 7941 NW 64 ST MIAMI FL 33166' SCOPES OF BUSINESS OR TRADE: FENCE INSTALLATION r AND REPAIR- Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by flung a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates ofelection to be exempt...apply only within the scope of the business or trade fisted on the notice of election to be exempt Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no Langer meets the requirements of this section for issuance of a certificate.The department shag revoke a MlCC71f1NM IRt+fl1d'12-1Fin9 PLEASE CUT OUT CARD BELOW AND RETAIN FOR FUTURE REFERENCE I— --—————_ _ —— -- — _ --------�IMPORTANT I STATE OF FLORIDA Pursuant to Chapter 440.05(14).F.S.,an officer of a corporation } I DEPARTMENT OF FINANCIAL SERVICES i who etacxs exemption from this chapter by fi►ing a certificate,of DIVISION OF WORKERS'COMPENSATION F election underthis section may not recoverbenefits or I CONSTRUCTION INDUSTRY EXEMPTION IO Compensation under this chapter. W R KERS'C M ELECTION t cTrotu To BE exErtPr Fttf�l PLdRIDA I L Pursuant to Chapter 440.05(12),F.S.,Certificates of election to I � I nwRtcERa�caaveNsr►TtoN taw - •• I EFFECTIVE onrE tonwzot4 {XPIRD be exempt_apply only within the scope of the business or trade 47M DAte: connote I listed on the nonce of election to be exempt. I I PERSON: TORRES, uyqRO I FEIN: 41221 5274 I H Pursuant to chapter 440.05(13),F.S.,Notices of election to be + BUSINESS NAME ANL] I E exempt and certificates of election to be exempt shall be i ADORE3S:I R subject to revocation if,at any time after the Ming of the notice ULTRA I Eor the - I notice or certificate no lonngera eperson the requirements f this I 17441 NW 64 ST section for issuance of a certificate.The department shall revoke MIAMI FL 33166 I a certificate at any time for failure of the person named on the certificate to meet,the requirements of this section. SCOPES OF BUSINESS OR TRA r -- = 08-15-2012 1 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS, COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 08/15/2012 EXPIRATION DATE: 08/15/2014 PERSON: TORRES LAZARO FEIN: 412215274 BUSINESS NAME AND ADDRESS: ULTRA FENCE INC 7941 NW 64 ST MIAMI FL 33166 SCOPES OF BUSINESS OR TRADE: 1- FENCE ERECTION-METAL IMPORTANT: Pursuant to Chapter 440 . 05041, F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.051121, F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.051131, F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413-1609 DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION Pursuant to Chapter 440.05114), F.S., an officer of a corporation who CONSTRUCTION INDUSTRY 0 elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA L under this section may not recover benefits or compensation under this WORKERS'COMPENSATION LAW 0 D chapter. EFFECTIVE: 08/15/2012 EXPIRATION DATE: 08/15/2014 Pursuant to Chapter 440.05112), F.S., Certificates of election to be PERSON: LAZARD TORRES H exempt.. apply only within the scope of the business or trade listed on FEIN: 412215274 E the notice of election to be exempt. R BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt ULTRA FENCE INC and certificates of election to be exempt shall be subject to revocation 7941 NW 64 ST if, at any time after the filing of the notice or the issuance of the MIAMI, FL 33166 certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE: person named on the certificate to meet the requirements of this 1- FENCE ERECTION-METAL section. QUESTIONS? (850) 413-1609 CUT HERE +► Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 Ultra Fence Inc 7941 NW 64 ST MIAMI FL 33166 CONTRACTOR WORK EXCEbtPT AFFIDAVIT Sate of F1 County of Miami-Dade Before me this day personally appeared Lazaro Torres who,being duty sworn,deposes and says: His workers compensation exempt form is attached for reference to pull out permit. Which expires 10/9/2016. 1. That he will be the only person working pn the project located at Swom to(or affirmed)and subscribed before me this day Of,-WW20 W 3Y 1 Personally Known Atofup ftft-ftft of F"s • Commb"•FF 210912 Aly Coaea.Expfra AN 7,2019 j 8ad1dfUrv*Md=df dryA=L ' e or stamp name of No i I • �oile>E,s Miami shores Village Building Department 10050 N.E.2nd Avenue RMiami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305)756.8972 Notice to Owner- Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the constriction industry may elect to be exempt i1 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: ner State of Florida County of Miami-Dade The foregoing was acknowledge fore me this T day of .20 /Q. By es 1 who• personally known to me has produced as identification. Notary: .a""'•� L;AN"AMRE6Lit- •`� `�; Notare of FloridaSEAL: •= Com210912My CoJul 7,2019tlondodlNotaryAsan. ASNOR193 Miami Shores Village Me M Building De ai tment 10050 N.E.2nd Avenue • ILDING REVIEW i Shores, Florida 33138 Rip; Tel: (305) 795.2204 APPROVED DATt Fax: (305) 756.8972 •••• . . .... ...... ...... .. . ...... WOOD FENCE DETAIL .... .... . . .... .... ..... Shadow Box Fences Good Side Out.The vertical and horizontal ••.... .... ..:..' vQ ` Vertical Picket supporting members of a fence shall face the •• •• see• ...... interior of the plot on which the fence is located •••••• .' o Board on Board ' ' • and the finished side shall face the adjoining •••••• lot or any abutting right-of-way. .. • 4x4 Post Spacing Fences<=5' high posts spaced at Ton center maximum Fences<=4' high posts spaced at 6"on center maximum Fence must not exceed 5'in height lx pickets fastened with two corrosion resistant fasteners per connection 2x4 horizontal pressure treated wood members with two corrosion resistant fasteners per connection 4x4 pressure treated posts embedded Tin concrete footing 10" diameter x 2'deep Li ALL wood must be pressure treated All fasteners must be corrosion resistant No less than two fasteners in any connection May 2009 i ��� E 1,eaC��1� 1� THC�ht' AS J. KELL..Y INC. FLORIDA 33144SURVEY NCI, LANE) SURVEYOR ` TE .1'80hle 444-7892 4" SHEET f_OF_d URVEY Qin h01 f] SUBDIVISION .r' - _ - __.. _. .. ____ BLOCK , 'ACCORDING To THE PLAT THEREOF AS RECORDED IN PLAT ROOK Na: �'UBUCAEC ORDSOF _ ATPAGENv,. � • COUNTY, FLORIDA. FOR: WCA,TION 5 ETCH _,. _ __, •_� J t N ME F I.A. INSURANCE RAT FWti a. -�- `� ;a,�,1372 AND I�fzWtSe<CI E�9,at�c�F I•,,. -t Ari }Ij ( 77 PUBLIvHE—i:��T�i1>r Mitt i'F I��I R� `.r •s•• a :*sl :. is PARTMENTOF 'f1M.t1•lDR�4s+.Ia: • trIUPMEi+I i DFeIyIWfjjF,S THEI•#EQ4Mf: • f 4* t .rIMPIE�ED LAND TQ T13faD ��r�il�►�.� �s••• Y� I®! r Cd k -10N •ys• yyr• •yy�• THIS IS,,4FLOOD RA?.A •sys ssss• �ry Oht •s ss •sus •sss• ! 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