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FW-17-1970 Miami Shores Village �,Perm/t Va:F <y� 10050 N.E.2nd Avenue NW � �O Clas caftot1. food +5ttPe Miami Shores,FL 33138-0000 Pam*Status.APPROVED, Phone: (305)795-2204 Iss��e tate 117tQ17' Expiration: 02JI3/201 Project Address Parcel Number Applicant 101 NW 100 Street 1131010220300 NOMADE REALTY LLC Miami Shores, FL 33150- Block: Lot: Owner Information Address Phone Cell NOMADE REALTY LLC 230 NE 107 Street (786)458-7799 (786)251-0138 MIAMI SHORES FL 33161- Contractor(s) Phone Cell Phone Valuation: $ 2,450.00 NEW STYLE FENCE&GATES INC (305)979-9651 Total Sq Feet: 150 Approved: Available Inspections: Comments: Inspection Type: Date Approved:: Final Date Denied: Foundation Type of Construction:Wood Fence Additional Info:WOOD FENCE horizontal 3.5 high an Review Planning Classification:Residential Scanning:3 Review Planning Review Building Review Building Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.60 Invoice# FW-8-17-64758 DBPR Fee $2.25 08/17/2017 Credit Card $ 118.30 $50.00 DCA Fee $2.25 Education Surcharge $0.60 08/03/2017 Credit Card $50.00 $0.00 Permit Fee-Wire&Wood $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $168.30 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 ify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction a onmg. u er authorize the above-named contractor to do the work stated. August 17,2017 Authors ed Si ature:O Applicant / Contractor / Agent Date Builds epartment Copy August 17,2017 1 Miami Shores Village Building Department RECEIVED 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 AUG U 3 20 !, Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20144� BUILDING master Permit No. Fu,)II—'ami-70 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP / CONTRACTOR DRAWINGS JOB ADDRESS: /Q' N���0'0 rhe e Com: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: ""/ Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): b toa Phone#: n Address: / 1% /02 S�� Ir City: (C,if, �nc/1 State: Zip: Tenant/Lessee Name: Phone#: ?9.` Email: SS aM In lk,Q -Com CONTRACTOR:Company Name: _ _MEGc/ �I�I.Q �-Qn(P C�_ 6cchs Phone#: 2&J q25 56n Address: 1ag7 o O SW City: H 1.4 -(( —State: FL Zip: 33 le f Qualifier Name: Y U/V( i;F ffo 0-1P S Phone#: .301cl X19 IF6s-I State Certification or Registration#: Certificate of Competency#: 8So0�7 DESIGNER:Architect/Engineer: Phone#: Address: / City: State: Zip: Value of Work for this Permit:$ deam/rC' J Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ®®❑ Repair/Replace ❑ Demolition Description of Work: A /�B -���� �° esti.( �- �P� mud P"I � ) Specify color of color thru tile: Submittal Fee$ - Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ yy TOTAL FEE NOW DUE$ I (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 wlikh 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. t Signature Signature 0 or AGENT ONTRACTOR The foregoi rument was acknowledged before me this The foregoing instr e�nit was acknowledged before me this 7> day of u 20 c 7 by 3 day of s LJ-A—l' J^t 201-7 by FAo s personally known to tr%A- %its personally known to me or who has produced � �-- as me or who has produced � 1)CzAyyj as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: tirJ0l6nd Abd�� / NOTARY PUBLIC: Sign6Q �A" // �: = Sign: ,.;a . ... Print ':�'� �:a= Pring � Seal: dR Seal: e9,tin. //0' •.. .•• \ \\ 9�1(� '�• 1rr APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) 6)od Q�.cam-�. � e l`�0'U' �/1 LEGEND AND AMVIATHINIS N -°� - 'Y MAP OF BOUNDARY SURVEY �'°�' -7pEE Q -.GANARffNT ALTAE a pAGE E .EMD ® - 1-7777771 "P. 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Paaeone�« mumP rraor a.drunam�exlaPaq#saarre `o O ri-14.7'/ 31.0 >r v'5�. rmueeeamawax-tea ��+ �TEIFPNCNfWAt�, 1 - '—%—[ �-''11.1' � '� 9 m m e� �_`-. •••••• � ® I�edpA��VFG'ffip /My� �D --Ria anarw°m,aienwere nmroake® e�wmr.1•mn°mra wmmAm,. e SAGIRAAT IE M �P 4'H N? Z - I [.Emunnmeev rvnea Ills mere de mk en ma aro r• �• PLANTE`Ri d o n°�dmwnan kw seneq e+op umlmw°ems me e�rome xeeam�C•euy, wn TAW[ c� �9•�WAI- I a nLE l 2s.o °satin srA �G/`�v I me rmeesn p°mnlmmn ams p Q STEPS mw waa°em°1n'41»w,aa pP1�¢nop11ct D :> 1II!�¢ 'v FOUND 'rnd.mwP 'mvu&kc "aNAmkFNede$1b�mm��'11' Z �PpavGGwwaa + I� J +a� m 4 �I ry0- IRO0 PI D)� -I rE'�wwemaai�aNev�edahwiB6 a,wn.No unae�ound reunmmn[ Luri POUND �I 7'O vwPGuaswvEr: g 0 � AtMUTMFTrr X I ON}OPIPE � �O�q )i 4 Ca Ihenm°roan�n°wevhmetlmpn. z m umllvanaNNwle (NO 1.0.) I .� I .� s idemunosAGAnGek LU LU Z • mnm - - LINO 6 4 d nGssku�dmgswwwmQ°amedarkekmdmxeaanaamlP dra o Q 2. (C&Mj IRON j 0 PIPE rrmsmr6eNe0an o - (NOLD.) a 'i ASPHALT AY b 8 �. rew mslm�rvin°m rmiw�`"ro wwrr'�mwv,°ae Slaae a°� 1Bavmwnl lk� eDoc Ga sl-1]a51t st![O52eQIMe FGmitlOHnmmvnve Cade ondmlmpmmwnGSlw, »v«x N cnkwerm" Nmdoaaas. vAVEA1(�{ TREET , Ian LL rM1 6"w __ ummPWw Tpe A� _ eG AmaAmisaTn __-. 16434.0.00 r-I GEAVEL MT:* _ ��amPEG - - j NWce I.aa,aaioel #bI wa .u>s°dmaaoPwAm lxenmdsuweror -r}`§! __ $ _. mid uoapm.Arffikvml"saw.eyu hrarm.inan�roegy,p v°dq are ponmeavmia,l me..mrenm ura q,e ro°rar• r b, 0 .• e.fees 00,000 . • • • •f . • 0 •e. s• 9 fees** • e•.fees • • oaf••• y • ..•.f• l f000 ,,• A- ••,0•• rf I� WWF 00 00 a 0 090:0 AN 0 0000 y • • • • • (J1)OO • • • sees.• •• • •sa • • • aXl�/ x � P• . . eAClk New Style Fence& Gates 12900 SW 132 Court—Miami,FL 33186 Date: (305)979-9651 ®�f�� State of FIC4-dek County of Before me this day personally appearedVC."ll-w-C4 /'Z.OiL /� who,being duly sworn, deposes and says: That he or she will be the only person working on the project located at: Xntractorure Sworn to(or affirmed)and subscribed before me this /S day of T� 20_L� By Personally Know ALEX J.SONZAIEZ Or Produced Identification Notary patio•Soft of Florida COMMela►*GO 043855 Type of Identification Produced r` My COMM.ExpM Oct 31.2020 �Y Print,Type or Stamp Name of Notary OR es lost ,,OMiami shores Village Building Department 'R'�tllQtflT�° 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner — Workers' Compensation Insurance Exemption f 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,parttime employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owne State of a County of Miami-Dade The foregoing was acknowledge before me this day of . ,20 I By Ss'41-Y✓ 5ru�C.LU .#-J who is pe on y kno to me or has produced 'cation. Notary. SEAL: e e-n;m o,1 i . r a O • M c�. CERTIFICATE OF LIABILITY INSURANCE °"E(mm"w°';'"' -- - ----- - --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: B the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. 9 SUBROGATION IS WAIVED,subject to the term 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 endomement(e). --- - PRODUCER �!dT WILVERALMARALES Wars Insurance Corp PHO74353 FAX (30 74-9994(305)2y, , ArA — - 10$37 SW 88th SL Ste 7-I waml7�stt.net - .. Miami,FL 33176 INSURER(S)AFFORDING COVERAGE_ NAIc a Phone (305)2744353 Fax (305)2749994 INSURER A; SENECA SPECIALTY INSURANCE CO INSURED INSURER B NEW STYLE FENCE&GATES INC I INSURER C: 12900 SW 132 Ct ousURE1 o- _ --- . ---- INSURER E: Miami, FL 33186- 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. - __ -- ----- ---. .------------- POLICY POLICY ADM EFF POLICY EXP NMI TYPE OF INSURANCE yy�p POLICY NUMBER LMM1DDfYY1fYj MM/DD/YYYY LIMITS U COMMERCIAL GENERAL LIABILITY FJICHOCCURRENCE $ 1,000,000 UCLAIM&.MADE V/ OCCUR DAMAGE TO RENTED 100,000 PREMISE8EEs ocamerus $ MED EXP(Any one priori) $ 5,000 A n - BAG-1049291 09/08/2016 09/08/2017 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 ® POLICY L_J JEC f_-1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 ❑ OTHER -- —--- --- $ ------ �Ok�INED SINGLE LIMIT - -- AUTOMOBILE LIABILITY Ee_acadent $ ANY AUTO BODILY INJURY(Per person) $ ❑ ULED AUTOS ONLY pRp�p�y OWNED [7 AUTOS BODILY INJURY(Per accident) $ HIRED n NON-OWNED PeracWderrt IMAGE $ AUTOS ONLY ❑ AUTOS ONLY $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE - $ ❑ DED ❑ RETENTION$ WORKERS COMPENSATION PER --- ❑ I 'l OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECIITIVE- 1 N f A E.L.EACH ACCIDENT $ OFFICERRV MBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ _If yes,descflbe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Athrch ACORD 101.Additional Remarks Schede,H more space Is required) FENCE ERECTION CONTRACTOR-METAL ERECTION LIC#12BS00464 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVE AUTHORED REPRESENTATIVE MIAMI SHORES,FL 33138 305-756-8972 WILVER ALMARALES ©IM-2015 ORD CORPORATION. All rights reserved. ACORD 25(2016103)QF The ACORD name and logo are registered marks of ACORD M uni ci pal Contractor's Tax %cei pt M iam i-Dade County, State of Florida THIS IS NOTA BILL-DO NOT PAY MC CC NO: 12BSD0464 of BUSINESS NAM E/LOCATION RECEIPT NO. EXPIRES NEMStYI:E FENCE&GA47ES WC 12900 W132 CT 7514882 SEPTEMBER 30, 2017 MIAMI,FL 33186 Pursuant to County Code Sec 10-24 TYPE OF BUSINESS OWNER SOEDXYBUILDINGCONTPACTOR PAYM ENT RECEIVED AXCOLLECTOR NBNSIYLEF9NCE&GA7�SWC BY TAX COLLECTOR 3125 08/15/2017 0223-17-007233 ReetHcted to City of Miami Shores KM Formoreinfanrr�tion vi�twww miamid�eaav/ta�ccdlectar 2017 FLORIDA LIMITED LIABILITY COMPANY ANNUAL REPORT FILED DOCUMENT#'L16000023113 Mar 05, 2017 Entity Name: NOMADE REALTY LLC Secretary of State Current Principal Place of Business: CC3016292577 230 NE 107TH STREET MIAMI SHORES, FL 33161 Current Mailing Address: 230 NE 107TH STREET MIAMI SHORES, FL 33161 FEI Number: 81-1326704 Certificate of Status Desired: No Name and Address of Current Registered Agent: BENJELLOUN,HASSAN 230 NE 107TH STREET MIAMI,FL 33161 US The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. SIGNATURE: Electronic Signature of Registered Agent Date Authorized Person(s) Detail Title AMBR Name BENJELLOUN,HASSAN Address 230 NE 107TH STREET City-State-Zip: MIAMI FL 33161 I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath;that I am a managing member or manager of the limited liability company or the receiver or trustee empowered to execute this report as required by Chapter 605,Florida Statutes;and that my name appears above,or on an attachment with all other like empowered. SIGNATURE:HASSAN BENJELLOUN MGR 03/05/2017 Electronic Signature of Signing Authorized Person(s)Detail Date