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Permit NO. FW-7-16-2083
Miami Shores Village Permit Type:Fence/Wall
10050 N.E.2nd Avenue NE Work Classification:Wood Fence
Per '
Miami Shores, FL 33138-0000 't
Permit Status:APPROVED
Phone: (305)795-2204
FtOR'lOp'
issue Date:7/26/2016 Expiration: 01/22/2017
Project Address Parcel Number Applicant
196 NE 105 Street 1121360130630
Miami Shores, FL 33138- Block: Lot: WILLIAM F HULME III IOANNA K
Owner Information Address Phone Cell
[LM F HULME III IOANNA 1155 NE 119 Street
- BISCAYNE PARK FL 33161-
1155 NE 119 Street
BISCAYNE PARK FL 33161-
Contractor(s) Phone Cell Phone Valuation: $ 1,500.00
DSB CONSTRUCTION CONTRACTOR: (786)222-9666 Total Sq Feet: 100
Approved: Available Inspections:
Comments:
Inspection Type:
Date Approved:: Final
Date Denied: Foundation
Type of Construction:Wood Fence Additional Info: Review Building
Classification:Residential Scanning: 1
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.20
Invoice# FW-7-16-60734
DBPR Fee $2.00 07/26/2016 Credit Card $ 110.20 $0.00
DCA Fee $2.00
Education Surcharge $0.40
Permit Fee-Wire&Wood $100.00
Scanning Fee $3.00
Technology Fee $1.60
Total: $110.20
r•1
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 AF (DAVIT: I certify ha all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction's d zoning. uth o , I authoriz the above-named contractor to do the work stated.
July 26, 2016
Acfthorized Signature.Owner / Applicant / Contractor / Agent Date
Building Department Copy
July 26, 2016 1
1
Miami Shores Village
Building DepartmentI JUL 2 2016
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
6YL
_
INSPECTION LINE PHONE NUMBER:(305)762-4949 — h
FBC 20 ( 4
BUILDING Master Permit No. 1 w -1-1b �3
PERMIT APPLICATION Sub Permit No.
&BUILDING ❑ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
PLUMBING ❑MECHANICAL MPUBLIC WORKS ❑CHANGE OF CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS:_ 11 (O fVL /0-5- S}'
City: Miami Shores County: Miami Dade zip: 3 3
Folio/Parcel#: Is the Building Historically Designated:Yes NO
Occupancy Type: Load: tt �� Con(struction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): W I 1� I a.V" [1 K'j Phone#:
Address: 116 JV 6 /Qs_ 151
City M[G WL( �UGY`P State: �" V -Zip: 33 13
Tenant/Lessee Name: Phone#:
Email: n
CONTRACTOR:Company Name: �� n�,cw JVCQC?c ()q\ \' (]CS Orf Phone#:
Address: 1S S (d 730,T
City: It fog (e CE(' State: ir_1. Zip: 33010..
Qualifier Name: /""f5 —ty t ,e',n Phone#:
State Certification or Registration M CIE5_01 1 L, Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#: 79b�
Address: City: State Zip:
Value of Work for this Permit:$ Square/linear F otage of Work: 1
Type of Work: ❑ Addition ElAlteration New Repair/Replace ❑ Demolition
Description of Work: �«tI L A his-
Specify color of color thru tile: h
Submittal Fee$ Permit Fee$ 100 0 CCF$ 20 CO/CC$
Scanning Fee$ 3 Radon Fee$ cQ DBPR$ 2 Notary$
Technology Fee$ Training/Education Fee$_Q . 4 o Double Fee$ `
Structural Reviews$��_ Bond$ i
TOTAL FEE NOW DUE$ 1 I O - Zo
(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 taws 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 Signature
OWNER or AGENT V / CONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
/ day of L _ 20 �by e� day of v/ 20 by
who is personally known to 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.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: Sign:
Print:
Print: G
""""' AGUSTIN EXPOSI 0 Seal: ati;A9P'••,, AGUSTIN EXPOSI
TIS
Seal: .•ipt'�`Y �� Notary Public-State of Florida �. Notary Public.State of Florida
•c My Comm.Expires May 31,2017 My Comm.Expires May 31,2017
Commission#F 017826 , Commission.#FF 017826
�i F�,• - a Assn.
**##### #**�Ppl)AOaTprPlilWM✓ylah Asea. *#****##�*#*#*#*## ##tfM �.*fAP�4RQ�ItY #****#*#**
APPROVED BY Pians Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
SN REs
'goal u11211" Miami Shores Village
+
Building Department
OR 10050 10050 N.E.2nd Avenue
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 covertlge. 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-
Owner
State of Florida
County of Miami-Dade /
The foregoing was acknowledge before me this day of �� / 20j .
By who is personally known to me or has produced
ication.
all ,p. AGUSTIN EXPOSITO
Notary: r Public Stat!of Flor &
y ' 7
SEAL: +TE commission#F FF t14 6 I
�h�OF F� `, J
Bonded Throi o llatiopal Nota6lt
Property Search Application - Miami-Dade County Page 1 of 2
OFFICE OF THF, PROPERTY APPRAISER
Summary Report
Generated On :7/21/2016
Property Information
Folio: 11-2136-013-0630
Property Address: 196 NE 105 ST
Miami Shores, FL 33138-2033
Owner WILLIAM F HULME III .
IONNA KONIDARI
Mailing Address 196 NE 105 ST .
MIAMI SHORES, FL 33138 USAs ,
Primary Zone 1000 SGL FAMILY-2101-2300 SQ
0101 RESIDENTIAL-SINGLE
Primary Land Use FAMILY: 1 UNIT
Beds/Baths/Half 5/4/0
Floors 1
Living Units 1
Actual Area 2,574 Sq.Ft
Living Area 2,274 Sq.Ft
Adjusted Area 2,416 Sq.Ft Taxable Value Information
Lot Size 13,819 Sq.Ft 2016; 2015 2014
-..._...__......._-_-.
Year Built 1940 County
Exemption Value $0 $0 $50,000
Assessment Information Taxable Value $378,012 $343,464 $109,215
Year 2016 2015 2014 School Board
Land Value $296,909 $245,272 $231,288 Exemption Value $0 $0 $25,000
Building Value $97,341 $97,139 $163,466 Taxable Value $395,641 $343,464 $134,215
XF Value $1,391 $1,053 $1,055 City
Market Value _ $395,641 $343,464 $395,809 Exemption Value $0 $0 $50,000
Assessed Value $378,012 $343,464 $159,215 Taxable Value $373,0121 $343,464 $109,215
Regional
Benefits Information Exemption Value $0 $01 50,000
Benefit Type 2016 2015 2014 Taxable Value $378,0121 $343,464 $109,215
Save Our Homes Assessment $236,594
Cap Reduction Sales Information
Assessment Previous OR Book-
Non-Homestead Cap R $17'629 Price Qualification Description
Reduction
Sale Page
Homestead Exemption $25,000 29051-
02/27/2014 $385,000 1462 Qual by exam of deed
Second Homestead Exemption $25,000
Note:Not all benefits are applicable to all Taxable Values(i.e.County, 06/01/2004 $0 22471- Sales which are disqualified as a result
School Board,City, Regional). 4527 of examination of the deed
12/01/1996 $129,000 17462- Sales which are qualified
Short Legal Description 1514
MIAMI SHORES SEC 5 PB 10-47
LOTS 1 &2 BLK 121
LOT SIZE 106.300 X 130
OR 17462-1514 1296 1
COC 22471-4527 06 2004 4
The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser
http://www.miamidade.gov/propertysearch/ 7/21/2016
_ STATE OF FLORID,
DEPARTMENT OF SINESS AND PROFESSIONAL R__JLATION
Y CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
PACHECO, LISSETTE
DSB CONSTRUCTION CONTRACTORS CORP
2525 W 3 CT
HIALEAH FL 33010
Congratulations! With this license you become one of the nearly
one million Floridians licensed by the Department of Business and
Professional Regulation. Our professionals and businesses range STATE OF FLORIDA
from architects to yacht brokers,from boxers to barbeque restaurants, I DEPARTMENT OF BUSINESS AND
and they keep Florida's economy strong. PROFESSIONAL REGULATION
,.
Every day we work to improve the way we do business in order to CGC1518896 '' ISSUED:' 07/06/2014 t
serve you better. For information about our services, please log onto ti r
www.myfloridalicense.com. There you can find more information CERTIFIED GENERAL CONTRACTOR
about our divisions and the regulations that impact you, subscribe PA CERTIFIED
GENERA R
to department newsletters and learn more about the Department's DSB CONST ISSETT N,CONTRACTORS CORP
initiatives.
r mission at the Department is: License Efficiently, Regulate Fairly. I, ~
constantly strive to serve you better so that you can serve your
-istomers. Thank you for doing business in Florida, IS CERTIFIED under the provisions of Ch.489 FS. I
and congratulations on your new license! Expiration date . AUG 31,2016 L1407060000504
DETACH HERE
RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY
STATE OF FLORIDA
' DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD -
'CGC1518896
Tfie'GENERAL CONTRACTOR
Named below IS CERTIFIED
Undertfie-provisions of Chapter 489 FS..
.Expiration date: -AUG31,.2016AL le
'„r_ .ems U ,
PACIiECO;LISSETTE _
ti
' DSB CONSTRUCTION CONTRACTORS CORP �-
-- —2525•VV,3 CT— .�---.�.r, �_ X
"HIS HFL33�01A�' \=��,``s-�� �
ISSUED: 07/06/2014 DISPLAY AS RFOIJIRFn RY I AW SFO# 114n7nFnnnnsn4
,
.4c R CERTIFICATE OF LIABILITY INSURANCE OATE(MM/DOIYYYY)
07/21/2016
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).
PRODUCERNME; T
TA
ROYAL CARIBBEAN INSURANCE AGENCY it PHONE 305-642-4541 F X No),305-642-1087
1772 WEST FLAGLER STREET ffiAD All ,JTUNONROYALIIOGMAIL.COM
MIAMI, FL 33135 INSURERS AFFORDING COVERAGE MAIC e
INSURER A:UNITED SPECIALTY INS.CO.
INSURED INSURER 8:
DSB CONSTRUCTION CONTRACTORS CORP. INSURER C:
2500 W 3 COURT#1 INSURER O:
HIALEAH, FL 33301 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.
INUCYPXP
T A TYPE OF INSURANCE ADDL R POLICY NUMBER MM C Y YYY MW D(YYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY S111003821388 12/18/201512/18/2016 EACNOCCURRENCE $ 1000000
CLAIMS-MADE ❑X OCCUR PREMIS $ 50,000
MED EXP(Any one person) $ 5A0
PERSONAL d ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000
POLICY PRO- LOC PRODUCTS-COMP/OP AGG $ 2.000,000
OTHER: $
AUTOMOBILE LIABILITY Ea accident INED I S
ANY AUTO BODILY INJURY(Per person) S
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS ROPERS
NON-OWNED TYDAMAG
HIRED AUTOS AUTOS (Per accfdantl
S
UMBRELLA UAB OCCUR EACH OCCURRENCE S
EXCESS LIAO CWMS-MADE AGGREGATE $
DED I I RETENTIONS $
WORKERS COMPENSATION PER 7E E H-
AND EMPLOYERS'LIABILITY Y I N
ANY PROPRIETOR/PARTNERIEXECUTIVE I E.L.EACH ACCIDENT $
OFFICER/M£MBEREXCLUDED? NIA
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S
M yes,describe under
DESCRIPTION OF OPERATIONS below E-L DISEA$E-POLICY LIMIT S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mon space is required)
GENERAL CONTRACTOR
CERTIFICATE HOLDER CANCELLATION
SHO �EEE
€ CRIBED POLICIES BE CANCELLED BEFORE
E EEOF, NOTICE WILL BE DELIVERED IN
VILLAGE OF MIAMI SHORES A CORPROVISIONS.
10050 N.E.2ND AVENUE
MIAMI SHORES,FLORIDA 33138 AUTH7v7w
11
-------.@t.1 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/011 The ACORD name and loco are reolatered marks of ACORD
002254
r.
LBT
Miami-Dade County, State & Florida
-THIS IS NOT A BILL - DO NOT PAY
6742721
WSMtIS llAMf/Lt "Twell 11 T MO.
DSB CONSTRUCTION CONTRACTORS CORP Be 11 MR WE It 30, 2016
2525 W 3 CT 1 7016181 Must be displayed at place of business
HIALEAH FL 33010 Pursuant to County Code
Chapter 8A-Art.9&•10
E
OWNER SEC.TYPE OF BUSINESSAPYMENT RECEIVED
DSB CONSTRUCTION CONTRACTORS 196 SPECIALTY BUILDING CONTRACTOR BY TAX COLLECTOR
CORP CCC1329197 $45.00 08/18/2015
Worker(s) 1 ECHECK-15-160081
This Local BusinessTax Receipt only confirms payment of the Local Business Tax.The Receipptt is not a license,
permit,or a certification of the holders qualifications,to do hasiaess. Holderaiust comply with any goveinmental
•or.noxgovernmental4egulatory laws and requirements which apply to the business.
The RECEPT N0.above must be displayea on all commercial vehicles-Miaifni-DoW Code Sec 88-276.
For more information,visit www miamidade ggv/tazce lector
Y
11 i 1100%
4
t
JEFF ATWATER
CHIEF 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 below has elected to be exempt from Florida Workers'Compensation law
EFFECTIVE DATE: 8/10/2014 EXPIRATION DATE: 8/9/2016
PERSON: PACHECO LISSETTE
FEIN: 264307423
BUSINESS NAME AND ADDRESS:
DSB CONSTRUCTION CONTRACTORS CORP
2525 WEST 3 CT#1
HIALEAH FL 33010
SCOPES OF BUSINESS OR TRADE:
LICENSED GENERAL LICENSED ROOFING
CONTRACTOR CONTRACTOR
Pursuant to Chapter 440 05(14)F S an ohrcer of a cwporabon who elects exemption fromNis dwpter by le ya cemficate of elect,"under that section may
not recover benerds of compansatem under this Chapter Pursuant to Chaplet 440 05(12)F 8 Cedfheates of electcn to be exempt apply onlywenn the scope
of me business or trade listed on the notice of efecnon to be exemat Pursuant to Chaplet 440 05(13).F 6 Nobeas of efeclon to be exempt anti xrtrfcnes of
election to be exempt shall be subject to revocabon it.at any time after the hung of the notice or the issuance of the Carbacate the person named an the notice or
ced,acate no longer,meets the reotnrements of this section for issuance of a coddicafe the department%hall revoke a Certlicate at ahy ten.lar isda!!of the
person named on the cerbroale to meet the reounements ofthls secton
DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 0712 QUESTIONS?(850)413.1609
https:Happs8.fldfs.com/erreportviewer/reportV iewer.aspx?data=kdvpginc9D7Q3gH6TER6e... 8/1/2014
5582 N.W.7th STREETSUITE202 SURVEY No. 14-0000259-1
MIAMI,FLORIDA 33126 t
* TELEPHONE:(305)264-2660 �§uruqjrrrz �✓ •
FAX:(305)264-0229
LAND SURVEYORS SHEET No. 2 OF 2
DRAWN BY: AL i
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bers of a fence shall fa
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of the lot on which the fence i
N ° I and the finish d side shall face th n+n
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lot or any ab 9 right-of-way.
• °' ' ' � 37.50'
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.._!;d�89-26.70.. ... s
SURES G�!
s I Miami shores Village
Building Department
j�lOy� 10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
WOOD FENCE DETAIL
❑ Shadow Box
❑ Vertical Picket
Board on Board
Fences < = 6' high posts spaced at 4' on center maximum
Fences < = 5' high posts spaced at 5' on center maximum
Fences < = 4' high posts spaced at 6' on center maximum
Fence must not exceed 6' in height
1x pickets fastened
with two corrosion
resistant fasteners per
connection
2x4 horizontal
pressure treated
wood members
with two corrosion
resistant fasteners
per connection
—71
L -J-
4x4 pressure treated
posts embedded 2'into
concrete footing 10"
diameter x 2'deep
ALL wood must be pressure treated
All fasteners must be corrosion resistant
No less than two fasteners in any connection
Revised 06/22/2015