FFW-12-1548Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 182604
Permit Number: FW -8 -12 -1548
Scheduled Inspection Date: December 17, 2012
Inspector: Bruhn, Norman
Owner: BORENSTEIN, NICOLE
Job Address: 441 GRAND CONCOURSE
Miami Shores, FL
Project: <NONE>
Contractor: ALL FENCING AND REPAIR
Permit Type: Fence/Wall
Inspection Type: Final
Work Classification: Wood Fence
Phone Number (786)258 -2484
Parcel Number 1132060170310
Phone: (954)306 -3477
Building Department Comments
INSTALL WOOD FENCE BOARD ON BOARD 5' HIGH
Infractio Passed Comments
INSPECTOR COMMENTS
False
Passed
-144
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- 177416. NO PERMIT ON SITE.
JR
December 14, 2012
For Inspections please call: (305)762 -4949
Page 34 of 41
IVI iami Shores V
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
RECEIPT
PERMIT #: Pc-NY-2- —") 54 DATE: I 14- 112
I,
❑ Contractor
❑ Owner
❑ Architect
(cDPu
W L 7-1
"Pi tZJ
ccaat t
Picked up 2 sets of plans and (other)
Address: Lt`'1( C�a
From the building department on this date in order to have corrections done to plans
And /or get County stamps. I understand that the plans need to be brought back to Miami
Shores Village Building Department to continue permitting process.
Acknowledged by:
PERMIT CLERK INITIAL:
RESUBMITTED DATE:
PERMIT CLERK INITIAL:
NA
U DING
PERMIT APPLICATION
FBC 20 rb
Permit Type: BUILDING ROOFING
OWNER: Name (Fee Simple Titleholder): /0 a cAtp,, 730( 4241 J
Address: '1 41 6)), DAD Nn
City: Q l e b+1 S\- o-
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
ECElVE
AUG 162 2
Permit No. 1 1 3-116
Master Permit No.
Phone #: 7-517 aNivi
State: 12 L zip: 33/3S
Tenant/Lessee Name: Phone#:
Email: A-Q.0 — d g 7 4 € _
JOB ADDRESS: `l 4 I G v s1m Con oor SC-
City: Miami Shores
Folio/Parcel #:
County:
Miami Dade
Zip: 3)i35
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: At t rein Cut q A1 E % W Phone #: "(MY 30a 397)
Address: toga K)k 50
City: State: Zip: 3336 f
Qualifier Name: W hYl
State Certification or Registration #: t Sj -%a,5, Certificate of Competency #:
Contact Phone #: Email Address:
DESIGNER: Architect/Engineer: Phone #:
Phone#:
Value of Work for this Permit: $ d 00 Square/Linear Footage of Work:
Type of Work: DAddition DAlteration
nom` t l-F or-
Description of Work:
2 1 5
DNew DRepair/Replace
cJoo& Vence SoArr1Q o,r)
ODemolition
o
Submittal Fee $ Permit Fee $
coy
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
le S(
TOTAL FEE NOW DUE $ � "'`� _ s U LI °
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, BOIT .FRS, HEATERS, TANKS and MR 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. p, n the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this b
day of &vtS, , 2011 —, by c Q
who is personally known toe or who has produced
dentification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
* ** * * * ** * * * ** ** *** * **
APPROVED BY
Signature
ontractor
The foregoing instrument was acknowledged before me this c'
day of Q(55 , 20 (2, by I &(-( C
who is personally known to me oz who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
.4v44„ CINTHYA COPLIN My Commission
•A: MY COMMISSION # EE114152
EXPIRES July 20, 2015
/671—.. Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
CIN YA COPLIN
MY COMMISSION # EE114152
EXPIRES July 20, 2015
�M s
Zoning
Clerk
A RECORDED DOPY MUST BE POSTED ON THE JOB SITE AT TIME DF FIRST INSPECTION
PERMIT NO: 11
STATE OF FLORIDA:
COUNTY OF MIAMI -DADE:
TAX FOUO NO. It (520 0 t 1 O O
1111111 11111 11111 11111 1 1111111111111111111111 •
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real
property, and in accordance .with Chapter 713, Florida Statutes, the following information
• is provided in-this Notice of Commencement.
1. Legal description of property and street/address:
CFN 2012R0595954
OR 8k 28240 F's 1219; Ups)
RECORDED 08/23/2012 09:05:42
HARVEY RUVIN/ CLERK OF COURT
MIAMI-DADE COUHTYv FLORIDA'
LAST F'AGE
Space above reserved for use of recording office
M- 1`.,ara:.Sko.420 c y• lot z. t¢ et- bl c)2 3
441 C`4,16.,nta C„oncovvsr. PC- 33139
2. Description of improvement: ar,t'i"Q i' e_
3. Owner(s) name and address: L.; li Arr Nevtste,..,rt `!44 1 Graoi zoncrx.rrs t A'C ; S1,0, e4 FL s,thf
Interest in property: At/
Name and address of fee simple titleholder. P4 1 A-
4. Contractor's name; address and phone number Etoli (-OAS+ •., Orr:.e,s 1004 Z /ow 50 ST— I L 3.1,11
g51l 304, _39-74
5. Surety: (Payment bond required by owner from contractor, if any)
Name, address and phone number: ft
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(1j(a)7., Florida Statutes,
Name, address and phone number.
8. In addition to himself, Owners designates ths following person(s) to receive a copy of the Uenor's Notice as provided in Section
�!
713.13(1)(b), Florida Statutes.
Name, address and phone number:
A
9. Expiration date of this Notice of Commencement: f q 26 '/ Z
. (the expiration • date is 1 year from the date of recording unless a different date is specified)
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES; AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE "• B SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFO'; COMMENCIQRK
OR RECORDING YOUR NOTICE OF COMMENCEMENT STATE OF FLORIDA, COUNTY OF DA• /
Signature(s) of • nbr�,
Prepared By _
Print Name LLtovin i 421+a Sri
Title/Office Own2c.
STATE OF FLORIDA
COUNTY OF MIAMI -DADE
The foregoing instrument wqk acknowledged before me this 29
By G.D ` 1.�, t�rv1 Nbkoc,42.A.W.ift
afdividually, or ❑ as for
personally known, or ❑ produced the following type of identification:
Signature of Notary Public:
Print Name:
(SEAL)
VERIFICATION PURSUANT TO SECTION 92.525, FLORIDA STATUTES
Under penalties of perjury, I declare that I have read the foregoing and
that the facts stated in It are true, to the best of my knowledge and belief.
Officer /Director/PartneiiNOWer RT' 'that cn,s's a
Prepare i
Print N
roilontegNESs my
ky
day of_ tR�
.ii
.1/0•
Signatures) of Ow (;r(s).
By
123.01 -52 PAGE 3 3/10
Owne�,
_ll �`'
a
CiiiTYA COPLtt
• �' =
w COMMISSION # EE114152
EXPIRES July 20, 2015
(40113$8-015
A .74 Officer/Director/Partner/Manager who signed above:
By
vir
PERMIT # 9J\ a, — I5-1 IIP
CONTRACTOR: f___
Fc_l
SUBMITTAL DATE:
1-1,4k ADDRESS:
C_oNs-
NAME:
RESUBMITAL DATES:
PROJECT TYPE:
� A
ZONE; ✓
ArVh
FIRE
STRUCTURAL
IMPACT FEES
ELECTRICAL
HRSIDERM
PLUMBING
NOC
MECHANICAL
B D
0
05- 03-2012
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:
PERSON:
FEIN:
05/03/2012 EXPIRATION DATE: 05/03/2014
CORACI MARY
650793922
BUSINESS NAME AND ADDRESS:
GOLD COAST INDUSTRIES INC
DBA ALL FENCING AND REPAIR
10681 NW 17TH PLACE
PLANTATION FL 33322
SCOPES OF BUSINESS OR TRADE:
1- FENCE ERECTION -METAL
IMPORTANT: Pursuant to Chapter 440 . 05114), 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 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
OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
PLEASE CUT OUT THE CARD BELOW AND .RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW
EFFECTIVE 05/03/2012 EXPIRATION DATE:
PERSON: MARY CORACI
FEIN: 850793922
BUSINESS NAME AND ADDRESS:
GOLD COAST INDUSTRIES INC
DBA ALL FENCING AND REPAIR
10681 NW 17TH PLACE
PLANTATION, FL 33322
SCOPE OF BUSINESS OR TRADE:
1- FENCE ERECTION -METAL
05/03/2014
IMPORTANT
OPursuant to Chapter 440.05(14), F.S., an officer of a corporation who
elects exemption from this chapter by filing a certificate of election
L under this section may not recover benefits or compensation under this
D chapter.
Pursuant to Chapter 440.05(12), F.S., Certificates of election to be
H
exempt... apply only within the scope of the business or trade listed on
E the notice of election to be exempt
R
E 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 certificate at any time for failure of the
person named on the certificate to meet the requirements of this
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
OP ID: AN
Ak r� CERTIFICATE OF LIABILITY INSURANCE
DA FOIE !
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 POUCIES
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(tes) 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 954. 452 -4900
BB Insurance Marketing, Inc.
P.O. Box 551267 954- 452 -0450
Fort Lauderdale, FL 33355 -1267
Jason Brown
CONTACT
Andrea Lopez ext. 314
, PHOII£ N,. E, 954- 452 -49W Fax 1 . sor 954 - 452 -0450
E-MAIL andrea@bbimi.com
ER
ID r:GOLDC-3
INSURERS) AFFORDING COVERAGE
NAIL #
INSURED Gold Coast industries, Inc.
dba All Fencing & Repair
10042 NW 50th Street
Sunrise, FL 33351
INSURER A :Travelers Property & Casualty
01899
INSURER B:
04/20/12
INSURER C:
EACH OCCURRENCE
INSURER D:
1,000,000
INSURER E :
PREMISES (Ea o )
INSURER F :
100,0013
COVERAGES
CERTIFICATE NUMBER:
THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDMONN 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 POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
TYP E OF INSURANCE
se
POUCYNUMBER
IMPA �
UVDTS
A
GENERAL
LIABNJTY
COMMERCIAL GENERAL UasIUTY
OCCUR
I- 660- 4667N820- IND-12
04/20/12
04/20/13
EACH OCCURRENCE
$
1,000,000
X
PREMISES (Ea o )
$
100,0013
1 CLAIMS -MADE 1 X
MED Ea) (Any one person)
$
5,000
PERSONAL & ADV INJURY
$
1,000,000
GENERAL AGGREGATE
$
2,000,00C
GEN'L
AGGREGATE LIMIT APPLES PER
POLICY 1-7 !Ng El LOC
PRODUCTS - COMP/OP AGG
$
2,000,000
A I
$
AUTOMOBILE
UABIUTY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON-OWNED AUTOS
COMBINED SINGLE LIMB
(Ea dent)
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per acc i ent)
$
$
$
UMBRELLA LIAO
EXCESS UAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION $
$
$
WORKERS
AND
ANYPROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER
0y��
DESCRIPTION
COMPENSATION
EMPLOYERS' LIABILITY
Y/N
N 1 A
ITWRCYTAAUTT5I 1 ER
EL EACH ACCIDENT
$
EXCLUDED?
In der
OF OPERATIONS
EL DISEASE - EA EMPLOYEE
$
below
EL DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (Attach ACORD 101, AddittonsI Renforks Schedule, Bmore space Is regi*sd)
Fence erector /Tile setter.
CERTIFICA
PINECES
Miami Shores Village
Building Department
10050 NE 2nd Ave
Miami Shores, FL 33138
I
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELNERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
�,�"
ACORD 25 (2009109)
m 1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD