Loading...
FW-16-1747 0� Miami Shores Village RECEIVED ow, Building Department JUN 2 3 2090 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 BY INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 I -i BUILDING Master PermitNo. VV (C� PERMIT APPLICATION sub Permit No. BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION [—]RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP i G CONTRACTOR DRAWINGS JOB ADDRESS: ,) 5 i) `� Jj City: Miami Shores -?t County: Miami Dade Zip: Folio/Parcel#: 11 1 —' -32 s®��J Lo Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: -FFllood Zone: BFE: 1 FFE: OWNER: Name(Fee Simple Titleholder): 0 Y yr k a4 d ��i 4& eL I e_y 56 7 Phone#: 3®�/3335 S Addrelss::' I�S 5o LE— yo t S City: Mug�M i State: f_7L_ Zip: 35 1 3 9 Tenant/Lessee Name: Phone#: Email: / j CONTRACTOR:Company Name: ®v l vlo C� L I LC Phone#: I) I 1 Address: �02.C) Zed �1 -�:, �L Z o City: � �i 1-A' , �(� S State: :V- �-- Zip: 3 3(�P Qualifier Name: �(o ay- C e t;' Phone#: `-3G5) '333 State Certification or Registration m e G-C 151 301 1T_Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ & -1 a o Square/Linear Footage of Work: ch Type of Work: ❑ Addition ❑ Alteration ❑ New ��dog` ❑ Repair/Replace ❑ Demolition Description of Work: G +n (l ® l L+ 1 e v Specify color of color thru tile: Submittal Fee$ Permit Fee$ c;L " CCF$ C .�,, CO/CC$ Scanning Fee$ - Radon Fee$ "CR) vq DBPR$ Notary$ C 11 Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) �r Bonding Company's Name(if applicable) /� Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) 1A 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 Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of J uftV e- 20 1 , by �� day of �-Ae ,20 J by who i i o i personally knowriito ���� J�/ ersonally known me or who has produced as Mme or w o`has produced identification and who did take a %011111111#11h� S'SICVF1111,fi identification and who did take an oath. NOTARY PUBLIC: SSl�,v� • �� NOTARY PUBLIC: Sign: = .o= Sign: Print: �i�9 q u '•`��'�� Print: ` �lI �✓c����� Seal: %Xf/L/' Ic�SIN,`��x Seal: tt.1f1 ° ;o.R ° JESSE WALTERS Notary Public-State of Florida «Qf My Comm.Expires Sep 23,2016 Commission#EE 837922 b APPROVED BY 7 I L Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CGC9523919 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 , PAREDES RAOLI, ELOY �. • INOCO BU11DlNG; LL OR 9600 NE 2NIIAVENti•� ��� �� ���. � i UAMI SHORES r, a ISSUED: 01/1912016 DISPLAY AS REQUIRED BY LAW sEQ# L1601190000463 Jbk3� me%Pt Qad lurtt , 18, f - �Tttts isNOTA41u 4 �Nt1T pAY 5#i�£S�S Pfi M fLt7CA tft}N { X f 0 C-0, 4Ri Q BtJ1L��NG LLC 3 . SEPTEMBER MTAtKtlt SFIQRES,.FL 33 $ ' >blustUd displayed of Piaci of pfrsrSs - Pursuant to County 00 _ Ct�alsisr 8A 3 8 1D OWSEC.TYPE OF B-UA+N-ESS CEIVEtY ORINOCO BWpAYM ENT LDINGLLC 19ti GENERAL.EUiLt71Nt eY'TAX cattEcrok ; G/Q E� UY PAREDES , CONTRACTIt , X46.,00 02/25/20't6 Workers) ; CGC1523919 X237-16-063037 his lac s Tax only cwt+'rrrs paym�t of the Lac�l Ilisiriess lax The F pt ism a l icer, iletmit,or "cation pft i llaldes's goal l"r quarts,W da-busimm%Holder mist cry with any gmaymw al _ter nongo> reakorjr*s and rapuimmm tstiv"apply tlt,tt>g rt The tr?T NQ abv*'n%st be displayed on al I Corr[rlpreial t zl�s iariir fade See ;8a 276. moreirdomration,Wsiti",nignc ar�v!#g�rer3te�toc 1 DATE(MWDDNYYY) AC40RO CERTIFICATE OF LIABILITY INSURANCE 06/15/2016 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 INTACT NAME: ANGEL GRAFFE 1Chester Insurance Services, Inc. PHONE rx, (954) 315-4000 FA7( Nei-(954) 420-9174 1761 W. Hillsboro Blvd -MAI .agraffe@hesterinsurance.com Suite 204 INSURERS AFFORDING COVERAGE NAICr1 . Deerfield Beach FL 33442- INSURER A WESTERN HERITAGE INSURANCE 1 INSURED ORINOCO BUILDING LLC INSURER B: i LICENSE CGC 1523919 INSURER C: 9620 NE 2ND AVE INSURER D: SUITE 207 INSURER E: MIAMI SHORES FL 33138- 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. INR ADDL SUOR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER M C_ A GENERAL LIABILITY IG06A010898-00 12/15/201512/15/2016 EACH OCCURRENCE $ 1,000,000 DAMAGET ENT D 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES a occur a ce $ CLAIMS-MADE a OCCUR / / / / MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 y GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 V _ POLICY PRO- LOC / / / / NOWND $JECT AUTOMOBILE LIABILITY COMBac INED SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED / / / / BODILY INJURY(Per accident) $ AUTOS NON OWNAUTOS ED / / / / PROPERTY DAMAGE $ HIRED AUTOS AUTOS / / / / $ UMBRELLA LIABOCCUR / / / / EACH OCCURRENCE $ EXCESSLJAB HCLAIMS-MADE / / / / AGGREGATE $ DED I RETENTION$ / / / / $ WORKERS COMPENSATION / J / / WC STATu- O RH. AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN N / / / / E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? I NIA (Mandatory In NH) / / / / E.L.DISEASE-EA EMPLOYE $ V yes,describe under / / / / E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below J DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more apace Is required) ,GENERAL CONTRACTOR - CGC 1523919 - REMODELING ONLY 7 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I MIAMI SHORES VILLAGE I BUILDING DEPARTMENT AUTHORIZED REPRE T 10050 NE 2ND AVE MIAMI SHORES FL 33138- I I ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. IINS025(20IM5).Ol The ACORD name and logo are registered marks of ACORD WE 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: 2/24/2016 EXPIRATION DATE: 2/23/2018 PERSON: PAREDES ELOY A FEIN: 475257690 BUSINESS NAME AND ADDRESS: ORINOCO BUILDING LLC 600 NE 98TH ST MIAMI SHORES FL 33138 SCOPES OF BUSINESS OR TRADE: LICENSED GENERAL CONTRACTOR Pursuant to Chapter 440.05(14),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 440.05(12),F.S.,Certificates of election to be exempt..apply only within the scope of the businesses or trade listed 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 longer meets the requirements of this section for issuance of a certificate.The department shall revoke a DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 SUBCONTRACTOR AGREEMENT This Agreement,as negotiated herein, is entered into by and between South Florida Fabrication&Fencing "Subcontractor"and ORINOCO BUILDING LLC,"Contractor."For good and valuable consideration,the , receipt and sufficiency of which is hereby acknowledged,Subcontractor and the Contractor hereby agree as follows: Article 1.Statement of Work: From time to time,Subcontractor may provide services to Contractor. In addition to the terms and conditions negotiated by the parties for particular projects,Contractor and Subcontractor hereby agree that the terms and conditions of this Subcontractor Agreement(the "Agreement")shall apply whenever Subcontractor provides services to Contractor. Article 2. Insurance:The Subcontractor,at its own expense,shall obtain and maintain in full force and effect,without interruption during the term of the Agreement,the following minimum levels of insurance:A.Workers'Compensation insurance,or exemption,covering the legal liability of the Contractor and its Subcontractors under the applicable workers'compensation or occupational disease laws for claims for personal injuries and death resulting there from to the Contractor and its Subcontractor's employees. B.Commercial General Liability insurance covering the legal liability (including liability assumed contractually,whether incidental or not)of the Subcontractor who may be engaged in the services,for claims for personal injuries(including death)and property damage resulting there from arising out of the services to be performed by the Subcontractor, in an amount not less than $500,000 for any one occurrence,$1,000,000 general aggregate(subject to a per project general aggregate provision),$1,000,000 Products/Completed Operations aggregate limit.Commercial General Liability insurance shall be obtained and shall include broad form contractual liability coverage, products/completed operations,cross liability,severability of interest and broad form property damage (if required),and Contractor as well as its directors,officers and employees shall be named as an additional insured on such Commercial General Liability policy regarding liability arising out of operations performed under this Agreement. The Subcontractor's insurance coverage shall be primary insurance as respects work on this project for Contractor, its directors, officers,and employees.Any insurance or self-insurance maintained by Contractor shall be excess of the Subcontractor's insurance.The Subcontractor,in its agreements with subcontractors,shall require subcontractors to obtain insurance meeting the minimum limits and incorporating the contractual requirements that are prescribed by this Section.The Subcontractor hereby waives and relinquishes any right of subrogation against Contractor and its agents, representatives,employees,and affiliates they might possess for any policy of insurance provided under this Section or under any State or Federal Workers'Compensation or Employer's Liability Act. Subcontractor shall require its insurer to notify Contractor thirty(30)days prior to the effective date of any cancellation or material change in any of the required policies.To the extent that the Subcontractor utilizes deductibles in conjunction with the insurance required by this Agreement,all deductible expenses will be assumed by the Subcontractor. Insurance shall be placed with insurers with a Best rating of not less than A-. Article 4. Indemnification and Arbitration:The work performed by the Subcontractor shall be at the risk of the Subcontractor exclusively.Subcontractor hereby indemnifies and holds Contractor, its parent and affiliates and their respective officers,directors,employees and agents,harmless from and against any and all claims,actions,losses,judgments,or expenses, including reasonable attorney's fees,arising from or in any way connected with the work performed,materials furnished,or services provided to Contractor during the term of this Agreement.Any controversy or claim arising out of or relating to this Agreement,or the breach thereof,shall be settled by binding arbitration and judgment on the award rendered by the arbitrator(s)may be entered in any court having jurisdiction thereof.The prevailing party in any arbitration concerning this Agreement shall be entitled to reasonable attorneys'fees. Article 5.Warranty:Subcontractor warrants its work for a period of year(s)against all defects in materials or workmanship. Article 6. Miscellaneous:Subcontractor is an independent contractor and not an employee of Contractor.This Agreement shall be in full force and effect from the date of signing unless canceled in writing by either party with thirty(30)days'written notice.The cancellation of this Agreement shall not negate any term or condition,such as the indemnity or insurance requirements.This Agreement is governed by the laws of the State of Florida.Any amendment(s)must be given in writing. SUBCONTRACTOR CONTRACTOR Company: South Florida Fabrication&Fencing Company: L!"i `1 v cc..) lso k By: �vt--IQ f\1'D �—at t�'S P-L-S By -� y PC"s#-A,.:-,e, Title: e Title: U" Date: 1�-l`��'j Date: �/ Z /� QUALIFYING TRADE(S) 0018 FENCE NJara N.Satan P.F- EM Sectetm.a the Soe/d -:/ Aftemi-Oath Zmody retabm al property ttgft heroin. wxwmiamltlatbe.govl�onomy _ CTQPI Board BUSINESS CERTIFICATE OF COMPETENCY .`` 13BS00086 SOUTH FLORIDA FABRICATION AND FENCM INN D.B.A.: IGLESIAS ANTONIO IGNACIO Is oertifled under the provisions of Chapter 10 of Mlami-DafteCOUW ^LID_FtiR Comm"- m U LL �f�9 006221 . ca + Mlaml-Dade.'Counter, St t �f Iodda -THIS iS iV0tA 131LC=i=:btu Nt)TPAY 7119116577 v OUSINESS-NAMEMOCATION RACEIPT NO. EXPIRES SOUTH FLORIDA FABRICATION AND FENCING INC RENEWAL SEPTEMBER 30* �d� 6989 SW I25 ST 71987,,32 Must be displayed,at plate of business:. PINECREST FL 33 156 _ Pursuant to Cbunty'Csde, Chapter l A- rt,-A9&. b OWNER SEC.TYPE OF BUSINESS PAYMENT HECEIV9 SOUTH FLORIDA FABRICATION 196 SPECIALTY BUILDING CONTRACTOR IFY rax cquEcrtst &FENCWG INC 138%0086 Ullixkeis) $45.00 09/30/2015 REDiTCARD—I5—OS2993 This-}nha l3usias t occeilu ltc�Sli mis paymeaiot kocat8asmassl ex The RecaFpt s Rd a Ikelm penult-oracertific�Bcrltiftl�ehold s lificehoas3a>labaal�ass.Holderaaust av{tk�aoygavatamet"I nr eengotna#nmeataFragn{atory IavY� �gairemen�whiohepplp to the basiniss -The REeHPt W0.aim�m�t 6e dkiye�:on ali eeamarcial ve�ie3les Miaml-Fella Curle�clia-Z76. '- Foralo[d�iifpr'ata600.vis�vmvwr.miamidade.��r Municipal Contractors Tax Receipt Mita -gide Co-�ntyr St�fe of lorrda FHISIS NOTA BILL-00 NOT PAY CC NO: 1385Q0086 BUSINESSNAM@ItOCATlON FT No. EXPIRES SOUTH FLOP FABRICATION AND 19EP`TEMSER 302'01 a . FENCING INC 5989 SW 125 ST 7423845 P1NEGf�ST,FL 33 t56 .; - _Pursuant to Csrun�y Coelll Sec SO-24 OWN@R TYPB OF BustNESS- PAYMENT RECEI1fED SOUTH FLORIDA FABRICATION SPECIALTY BUILf3ING COT�3*C1'GR sY TAX 0TRECETOR B;FENCING INC 175.00 10/05/2015' ,v Q0 ANTONIO IGLESn PRESIDENT, 0245-16-000017 TMs receipt is oot vefi'In:in Nre fallowing Mmucfgelities:Am tare,Doral,HidomI Key Bfscayae, L% Bard! MFitml fe4as,Palmolto Hay,PbwcniA Sump Was Beack Towoof Caller day. M® Fo>wore laWmation,visit w&-m miamidad®.gevbmileetor •� ® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 03/03/2016 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 WANED, 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 MARIO PELGREN NAME: INTELI INSURANCE,INC PHGNE 305-666-1404 Fax No Ext• A C No): 4970 SW 72 AVE.STE#107 ,pD : agency@royaltyinsurancegroup.com INSURER(S)AFFORDING COVERAGE NAIC# MIAMI FL 33176 INSURERA: Granada 0 INSURED INSURER B: SOUTH FLORIDA FABRICATION AND FENCING INC. INSURERC: 6989 SW 125 ST. INSURER D: INSURER E: PINECREST FL 33156 INSURER F: COVERAGES CERTIFICATE NUMBERn 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. IPOLICY EFF P TYPE OF INSURANCE POLICY NUMBER MMMIDI MMIDD LTR EXP LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEIT-- COMMERCIAL GENERAL LIABILITY PREMISES Ea urrence $ 100,000 CLAIMS-MADE ®OCCUR MED EXP(Any one person) $ 5,000 A 0185FL00043703 03/04/2016 03/04/2017 PERSONAL a ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY 'P'RO- ECT O El LOC $ AUTOMOBILE LIABILITY COMBINED SINRULE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION TORY L M U- O R AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOWPARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERWEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) LIC#13BS00086 I CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE Z AVE. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI SHORES,FL. 33138 AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) O 1988-2010 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD 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: 3/10/2015 EXPIRATION DATE: 3/9/2017 PERSON: IGLESIAS ANTONIO I FEIN: 460805816 BUSINESS NAME AND ADDRESS: SOUTH FLORIDA FABRICATION AND FENCING 6989 SW 125 ST. PINECREST FL 33156 SCOPES OF BUSINESS OR TRADE: FENCE INSTALLATION AND REPAIR- Pursuant to Chapter 440.05(14),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 440.05(12),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 440.05(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 longer meats the requirements of this section for issuance of a certificate.The department shall revoke a certificate at DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 Permit A � -' 1 3t Pa ■ P ehO� L� Miami Shores VillageAmokk Ar 10050 N.E.2nd Avenue NE NLAV1 �; WQ*Clsstlt?atC? ; E3Ct6' , Miami Shores,FL 33138-0000 Perms aceta is APpRo�I� h � Phone: (305)795-2204 oRiv 7I 2tZt>1 Expiration: 01/08/2017 Project Address Parcel Number Applicant 1350 NE 101 Street 1132050230020 DIRK&ELIZABETH PETERSON Miami Shores, FL Block: Lot: f Owner Information Address Phone Cell DIRK 8,ELIZABETH PETERSON 1350 NE 101 ST MIAMI SHORES FL 33138-2611 Contractor(s) Phone Cell Phone Valuation: $ 9,767.70 ORINOCO CONSTRUCTIONS, INC (786)531-9479 Total Sq Feet: 120.9 Approved: Available Inspections: Comments: Inspection Type: Date Approved: Final Date Denied: Foundation Type of Construction:Wood Fence Additional Info:CHAIN LINK FENCE ONT HE SIDES. Review Planning Classification:Residential Scanning:3 Review Building Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $6.00 Invoice# FW-6-16-60308 DBPR Fee $2.00 06/23/2016 Credit Card $50.00 $104.90 DCA Fee $2.00 Education Surcharge $2.00 07/12/2016 Credit Card $ 104.90 $0.00 Notary Fee $5.00 Permit Fee-Wire&Wood $120.90 Scanning Fee $9.00 Technology Fee $8.00 Total: $154.90 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 at all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the abov - cor t the work stated. July 12, 2016 Authorized Signature:Owner / Applican / Corftradtor / Agent Date Building Department Copy July 12,2016 1 PLAN OF SURVEY SCALE 1"=30' d Fences Good - 513y ��.� � supporting rT, horizontal BISCAYNE BAY interior of the F 'h,Zli face the �i � 2�1� and the finishe. e 1S?OU led ` R=21&40 lot or any abuttin, tfle ataj011iingA . ......• � 0000•• • • 0000•• LC) T0:1'—�_ 008000 :•0 •0 • • Mn 1/6 • 0000 • •• 00006 J 4:1' 10S' 6 6 6 • • 88 60 08 00 0008•• • • 0 • • •0060• ••666• PALM t 1' C0001A}iS*2 •6 0 6 • ..1111w f/1iC . .. • ° FENCE MMMMe 2 2&15' 1.' ISS POS. •^ PUWS NNMNM SHS C •° W PAVERS IE@C 0 N 21.70' F nces Good Side Out. The vertite I and rizont : % Nc S Ipporting members of a fen's ce th ir lerior of the plot on which the fence i 99 j ' N GAS tAFHc 9 a Id the finished side shall face thea joi ' C.B.S. ` o o < or any abutting right-of-way. a w J 26b5' co 3' L LL. Z P0 UP 21.40 l0 MWW is 08I e J L „`y, 1 Q C PAW! 0• 2170' Z • °. WAM 0. I ° LJ .° 1/2•PW ° AE18Al I1J�S` �g� y •aY I C CW) —— • RnA„ID 1/2• `''1' C C, J FM HMW i} • Li LJ AVIXADO i.1' S c3WX f PAVERS c PA U& Wx19 RM l POtNMW +2WPAyE W Cv N.E. 101st ST. t o( �v v ear PROPERTY ADDRESS: i— A A 1350 N.E. 101st ST. 2u c e MIAMI SHORES, FL. 3 1 8 - � U Q'W bra WoC-1 �� Q-5 Q t <r lI-��1�c�ti� ofv�� Sel _c�os�vt IiCi ��, Cuc� c,��� • (n a..ARc D�rawcE A/c...aiR CON01RO1ID4G css..ca1E eLacic 0.u.1....ovEw1EAD uram LBdE cL...ca" c/L_.cEN1ac LOIE RAD._RAOVVI� !M4CROACH" �ov Z R/W...RIGHT OF WAY FIP...Wo 001 PIPE OM-UM HFAD WA-WATER MEIER C.H».OM 03WE PA—MMM UNE CONC_CM4CRETE RLIN HYDRANT UP-IJ WIY POLE O R.-MIUS US-UMM EASEMENT A- TW ANGLE PL_.PIANTER T...TANGM CA-CATCHMN D...DIAMETER H._HEOIT S...SPREAD W BENCH MARK USED: DADE COUNTY B26 RA. ELEVATION: 17.23' 13-7332 LOCATION SKETCH SCALE 1"=100' N.E. 102nd STREET . . .... •• ••• w 6 1 • 0. Q Q C_ .... .. .. .. 5 2 s 2 O ...... .. ••' 4-r • ••• • • LLj •• • • • • z 3 z 3 •••.•. • . 0 0000 ..4 ••• • N.E. 101st STR ag.43' e s Good Side Out. The vertical and I zo, Supp rting members of a fence Ointerio of the plot on which fact, 1 d t finished Sid ence is Ic���;;. 3 loft or all face the adjoinrr, d 1 y abu , right-of-way. 1 BISCAYNE BAY LEGAL DESCRIPTION: LOT 2, BLOCK 1, MIAMI SHORES BAY PARK ESTATES, ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 55, PAGE 83 OF THE PUBLIC RECORDS OF MIAMI—DADE COUNTY, FLORIDA. GENERAL NOTES 1) OWNERSHIP IS SUBJECT TO OPINION OF TITLE. 2) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY, AFFECTING THIS PROPERTY 3) (2.22) DENOTES THOSE ELEVATIONS REFERRED TO N.G.V. DATUM. 4) LOCATION AND IDENTIFICATION OF UTILITIES ON AND/OR ADJACENT TO THE PROPERTY WERE NOT SECURED AS SUCH INFORMATION WAS NOT REQUESTED. 5) THIS PROPERTY IS WITHIN THE LIMITS OF THE FLOOD ZONE AF BASE FLOOD ELEVATION: 9 FEET 6) NO UNDERGROUND LOCATIONS WERE DONE BY THIS COMPANY. UPDATE:APRIL 29, 2015 CERTIFIED T0: UPDATE:JANUARY 19, 2015 UPDATE:OCTOBER 28, 2013 DATE: MAY 06, 2013 APLICABLE ZONING, UNDERGROUND, ZONING AND BUILDING SET BACKS. MUST BE CHECKED 13Y OWNER, ARCHITEC OR BUILDER BEFORE DESIGN OR CONTRUCTION BEGINS ON THIS PROPERTY. IHEREBY CERTIFY : That the attached Plan of Survey of the above described property Is true and correct to the best of my knowledge, information and belief, as recently surveyed and platted under my direction, also that there are not above—ground encroachments other that those shown. This survey meets the mmimun technical standards U N ITEC that those shown. This survey meets the minimun technical standards set forth by the Florida Board of Land Surveyors pursuant to chapter 61G17-6, Florida Administrative Code, Section 472-027, Florida Statutes. SURVEYING, INC. LB. No. 3333 SO 6187 NW 167th STREET, H-5 LAZAD. ANS PROFESSIONAL AL LANDD SURVEYOR PHONE:FLORIDA,005) 51264940 THIS I S A BOUNDARY SURVEY 15 CERTIFICATESTATFLo�DAso NOT VALID UNLESS SEALED WITH AN EMBOSSED SURVEYOR'S SEAL ;.I Peace PEs r,it ;,.pp ICat at o, i "i or j �5?e Nj r iC)'t /i{cs ij Shore. J tJ Similar aluminum and wood gate built on property at 1550 NE 103rd St, Miami Shores?�Yr s f p. vfi • • i • { •.•• . •• •.f.r • Daae4W06 - i•w..• ,. • �ts E:7' Side Out. T7th horizoiembers ofl face ti.Proposed aluminum frame and horizontal wood slats plot on whis locatihed side sdjoining tting right r 3/4 — —— f i 4' IY �— — Grade r OR�s i01 Miami Shores Village oil Fences Good Side Out. The vertical and horizontal wilding Department sJl supporting members of a fence shall face the interior of the plot on which the fence is located and the finished side shall face the adjoining 10050 N.E.2nd Avenue �L0R' �p► lot or any abutting right-of-way. Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHAIN LINK FENCE DESIGN DETAIL Fence Terminal Post Line Post Dimensions Terminal Post Line Post Concrete Height (ft) Dimensions (in inches) Concrete Foundation Size (in inches) (o.d.X wall thickness) Foundation Size (diameter X depth) (o.d.X wall thickness) (diameter X depth) (in inches) (in inches Up to 4 2 3/8 x 0.042 1 15/8 x 0.047 10 x 24 8 x 24 Over 4 to 6 2 3/8 x 0.042 17/8 x 0.055 10 x 24 8 x 24 For SI: 1 inch=25.4 mm. NOTES: 1. This table is applicable only to fences with unrestricted airflow. ••• 2. Fabric: 12 '/z gauge minimum,Black or Green. • • •• *see** 3. Tension bands: Use one less than the height of the fence in feet evenly spaced. *.so .... • 4. Fabric Ties:Must minimum the same gauge of the fabric. a o r t. *.so ....;. 5. Fabric Tie Spacing on the Top Rail:Five ties between posts evenly spaced. see:t• . . 6. Fabric Tie Spacing on Line Posts:One less than height of the fence in feet,evenlyspaced. s. •": 7. Either top rail or top tension wire shall be used. *see • •s sets* 8. Braces must be used at Terminal Posts if top tension wire is used instead of Top Mit.••: s• 0 ••e e• 9. Post Spacing: 10 foot(3m)on center maximum. se so se ee seteee 10. Post shall be embedded to within 6 inches(152 mm)from bottom of the foundatio.•;s; s • 11. In order to follow the contour of the land, the bottom of the fence may clear the'contodr of t1lG gond by`• ••• up to 5 inch(127 mm)without increasing table values to the next higher limit. : t•s ' •:..,.. er • etre • NOTICE TO PROPERTIES WITH POOLS: .s If the fence is to meet the criteria as a pool barrier, the fence shall not be climbable and all rails must be placed facing the inside of the property.Pedestrian gates shall have self-closing and latching devices installed at the minimum of 54"above ground.For further details see Section R4501.7.1 of FBC. Rev.10-08-15 I.Naranjo SgOREs+ D� t� Miami shores Village Building Department 10050 N.E.2nd Avenue jAR1DA Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exem tion 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: I. 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 fore oing wasT�� owledge before me this day of� ,20 . By Q�� who is p rsonally known t me or has produced as identification. Notary: IWA DER R SEAL: NoWy RW SM d FbfldB mm sou M 07,2D19 B011did en-WmApW,IIIc.OMWI48541 South Florida Fabrication and Fencing Inc 13BS00086 State of Florida County of Miami-Dade Before me this day personally appeared Antonio I Iglesias who,being duly sworn, deposes and says: That he will be the only person working on the project located at 1350 NE 101St St. Miami Shores, FL 33138. Sworn to (or affirmed) and subscribed before me this day of _Z3o� v 2016,by �Y,1o��0 ���2S•�S Signature -7 5A Date Personally know OR Produced Identification Type of Identification Produced A kY 6 Pec-cZ Print,Type or Stamp of Notary MAYBI PEREZ * * MY COMMISSION#FF 131383 EXPIRES:June 10,2018 WedThrUBWONO"SWIM 6989 SW 125 St, Pinecrest, FL 33156 NOTICE OF COMMENCEMENT CFN 2 C 17R B 1 d 8,.8833 A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTIOpF BK 3 431 l''9 2467 (1P9s) RECORDED 02/2.3/2017 11:1:;15 HARVEY R:UVINY CLERK OF COURT PERMIT NO.r� TAX FOLIO NO. MIAMI-DADE COUNTY? FLORIDA STATE OF FLORIDA: COUNTY OF MIAMI-DADE: STATE OF FLORIDA,COUNTY OF DADE `yq ccu�,Ty� d BV E'RTIFyy til at this is a true COPY of the `P Es r THE UNDERSIGNED hereby gives notice that improvements will �� i de#p.cgctai re �a.�__deY of property, and in accordance with Chapter 713, Florida Statutes, th _ Don a 20 is provided in this Notice of Commencement. 6 ;TtVF fitY arra arra t`friClai Soal.and C�wnty Courts HARVEY R CLEM} Cv gaoECool. ;,* 1. Legal description of property and street/address: 6 I � 13 o N- 101 _f Y,e e-+, Pt i n•v) m S 3 3 2. Description of improvement: '1�nS�rzll Chain aP _f:,. 3. Owner(s)name and address: Q,r 14_ a v1 t-1 i Interest in property: Name and address of fee simple titleholder: 4. Contractor's name and address: OfCn�Ci7 �o:�s�IC'fior'1 5. Surety: (Payment bond required by owner from contractor, if any) Name and Address: Amount of bond $ 6. Lender's name and address: 7. Persons within the state of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name and Address: 8. In addition to himself, Owners designates the following person(s)to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name and Address: 9. Expiration date of this Notice of Commencement: (the expiration date is 1 year from the date of recording unless a different date is specified) Signature of Owner Print Owner's Name �, F, '���'D�. Prepared by Sworn to and subscribed before me this �a day of 20 Address: J Notary Public. +- Print Notary's Name: It L My commission expires: IRA DERIFILIE Notwy PubNG,State of Fbdda LW=m.vom May 07.2019 No.FF 226557 SOndeQ ttw AWw ,hm=14M4