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FW-12-669Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 173214 Permit Number: FW -4 -12 -669 Scheduled Inspection Date: May 17, 2012 Inspector: Bruhn, Norman Owner: Wiborg, Brian Job Address: 38 NE 108 Street Miami Shores, FL 33161- Project: <NONE> Contractor: ARTEMISA FENCE CORP Permit Type: FenceIWaII Inspection Type: Final Work Classification: Wire Fence Phone Number Parcel Number 1121360110050 Phone: 305 - 221 -0214 Building Department Comments 29' WOOD FENCE 5' HIGH AND 91' CHAIN LINK FENCE 4' HIGH Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 172435. Clean up debris and provide base for gate rollers. NB c May 16, 2012 For Inspections please call: (305)762 -4949 Page 22 of 32 QG 1-11 B DING PERMIT APPLICATION FBC 20 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit Type: BUILDING ROOFING IMOMEV'M; al APR 1 6 2012 Permit No.-FLO �� (09. Master Permit No. OWNER: Name (Fee Simple Titleholder): ► an ULD ■∎Noor 5 Phone#: c306) -rcacO - Loq1-cl Address: NE 1fo-K" `r'ee'fs City: O.t m SM1 tXe s State: 'F-'1- Zip: Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: OS t `l-`` S-k." • City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: +r- -t SA Ce, eVOTActreNteilart -1 2 -O2-14 Address: 11 l 1 l.:t h CO -k v.. 9-cal 'Sc1 City: O�.w..• O'.G&ik State: •• Qualifier Name:Q .ct17, V•6-� State Certification or Registration #: AC�ertificate of Competency #: Contact Phone#:*, 2 Z1 - Cb 7, l 44 Rmail Address: /" I x d I Q n �- x.41 c AA. t S# r "CRA^ ca. DESIGNER: Architect/Engineer: Phony#: Zip: 5v 1 3°h, Phone#: lw a-) 2-24 - 0219 r Value of Work for this Permit: $ Z) 3 06 — Square/ Linear Footage of Work: / O 0 °Repair/Replace ❑Demolition QI° Ci- 1/ii�S Type of Work: DAddition DAlteration Description of Work: 2 q` w o o ��,.► e. Li ` 14 r • ❑New 6 1-! T- ************* * *** * * * * ******:x**** **** era *F ***********w******************************** Submittal Fee $ Permit Fee $ /0 Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Structural Review $ able Fee $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FJ E NOW DUE $ I (p J 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 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 Owner or Agent The foregoing instrument was acknowledged before me thisZC. day of 1M ck.,20L by eia� Libor' who is personally known to me or who has produced \d" As identification and who did take an oath. NOTARY PUB C: APPROVED BY V)1ew- Signature Contractor The foregoing instrument was acknowledged before me this day of YlAdcJL , 20 1 z- , by CCfwc,-cL who is personally known to me or who has produced b ' ° as identification and who did take an oath. Plans Examiner Structural Review (Revised 07 /10/07)(Revised 06/ 10/2009)(Revised 3/15/09) ********** T * ** *********** LI fT/Zoning Clerk 13056758163 From: EDUARDO VALDES 2012 -04-25 16:16:57 (GMT) To: Miami sh tiengai'0,44VA, .. • T.iili.iii fiiici.cuiziiiiiltilT.4( CO ..- • EtimR1101.I: VALDEZ' :PRE5:.: .:.•.,.*: - , .: . 11,11(..LINCOLN Rk.400 ',•' !. ,,.• : • ::: ' • Mi.AN 4.EAgN FL••: 3.319 1"..: ': . • : • • . . . . : ., . . . ; . . - . . t.t.s.i1:4,1/ofalfili „A... • P P Q D D' „ . . • • .• , . . . • A,RTEMISA .FENCE ORNAifOTAL, CORP • • gIWARDO r VALDEZ FRET ,• ., • • • 1111 LINCOLN RD. 400: , • • • ., • '. NIANI BEACH FL 33./n..'. • • • • . . . , . . . . • 12.131i1,111)111111.1lliii11.1.11.111.1111it 1 t111111111 nt , • . . • • ,." • ...... ........ , . • . • •• . . . . . . • • • .. .. . " To: Miami shores Page 2 of 2 2012 -04-25 15:51:19 (GMT) 13056758163 From: EDUARDO VALDES OP ID: ILGU A1�'`"�V CERTIFICATE OF LIABILITY INSURANCE DATE 04/13DIYYYY) 04/13/12 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(ies) 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 305- 262 -5244 All Safe Insurance 7171 Coral Way #209 786- 388 -7244 Miami, FL 33155 Jorge Pena, PIAM CONTACT (PAHIC No, Ext. I (AIC, No): E -MAIL ADDRESS: PRODUCER ARTEM -1 CUSTOMER ID &: INSURER(S) AFFORDING COVERAGE NAIC 0 INSURED Artemlsa Fence & Ornamental Inc 5601 Collins Avenue #1808 Miami Beach, FL 33140 INSURER A: ENDURANCE AMERICAN 10641 INSURER B: PROGRESSIVE INSURANCE 10193 INSURER C: BRIDGEFIELD CASUALTY INS CO. 10336 INSURER D : (Ea nonce) MED EXP (Any one person) INSURER E : X INSURER F : PERSONAL & ADV INJURY CERTIFICATE 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. INSR LTR TYPEOFINSURANCE 4D-DL INSR SOBR WVD POLICY NUMBER CBC10000811800 POLICY EFF (MMIDDIYYYY) 01/21/12 POLICY EXP (MMIDD/YYYY) 01/21/13 LIMITS EACH OCCURRENCE $ 1,000,000 A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY OCCUR X PRE/ SET occu $ 100,000 CLAIMS -MADE X (Ea nonce) MED EXP (Any one person) $ 5,000 X PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 111.170- & �LOC PRODUCTS - COMP /OP AGG $ 1,000,000 $ B B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS PIP FULL 07783448 -1 07783448 -1 07783448 -1 07783448 -1 01/06/12 01/06/12 01/06/12 01/06/12 01/06/13 01/06/13 01/06/13 01/06/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident) $ X $ X $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEY OFFICER /MEMBER EXCLUDED? (Mandatory inNH) If s, describe under DESCRIPTION OF OPERATIONS /N NIA 196 -21125 05/16/11 05/16/12 WC STATU T x TORY LIMITS I OER H ❑ below E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE EA EMPLOYEE $ 1,000 000 , E.L. DISEASE- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) FENCE INSTALLATION COMPANY •ce•rcrra•c ur• ..•. CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD Mar 26 12 03:16p Wiborg N.E FD.NAfL 2 75.a ' (RIM) 108TH 16'A S Pf-1. RO40 . 187' T 340' x_21 3 --_ 3057582286 p2 �TREET- Ac3P1 -L . PAv. '4' SHEET 2 OF 2 U 21' 12.8' PL • g .00 17.20' rM • 0 J 001 '3CREENE O FO IAA. W.M 0.0 • U, � z —L i 2 c.) ipp a p O Ci FD.NAtL • 2 -6 1-24' CL THOMAS J. KELLY, INC. L9. #6496 SURVEYORS - MAPPERS -LAND PLANNERS 8125 SW 120 STREET PINEAST. FLORIDA 33156 (786) 242 -7692 DADE (984) 779 -3288 BAWD (786) 242-6494 DADE FAX (984) 779 -3260 9RWD FAX 46 (DATE FIELD WORK 'SCALE o �St1RVEY NO. 02 -8-10 I 3 '20 11 IO -C166 Igo! 'kikol.,.. .,,,. mi.. . O FO IAA. W.M 0.0 • U, � z —L i 2 c.) ipp a p O Ci FD.NAtL • 2 -6 1-24' CL THOMAS J. KELLY, INC. L9. #6496 SURVEYORS - MAPPERS -LAND PLANNERS 8125 SW 120 STREET PINEAST. FLORIDA 33156 (786) 242 -7692 DADE (984) 779 -3288 BAWD (786) 242-6494 DADE FAX (984) 779 -3260 9RWD FAX 46 (DATE FIELD WORK 'SCALE o �St1RVEY NO. 02 -8-10 I 3 '20 11 IO -C166