FW-12-1260Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 178493 Permit Number: FW -7 -12 -1260
Scheduled Inspection Date: October 02, 2012
Inspector: Bruhn, Norman
Owner: , DUSA ACQUISITION LLC
Job Address: 455 NE 91 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: KATE CONSTRUCTION CORP
Permit Type: Fence/Wall
Inspection Type: Final
Work Classification: Wood Fence
Phone Number (305)496 -7442
Parcel Number 1132060140140
Phone: (954)609 -1076
Building Department Comments
INSTALLATION OF NEW WOOD FENCE
Infractio Passed Comments
INSPECTOR COMMENTS
False
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- 175591. Not Ready
October 01, 2012
For Inspections please call: (305)762 -4949
Page 8 of 20
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
.1)4.1k INSPECTION'S PHONE NUMBER: (305) 762.4949
/ IJI 2 Nom' W i li
B ING
PERMIT APPLICATION
JUL IL
BY: om--- 7- oao° --
FBC 20
Permit No. 13aZ1 � 1`40
Master Permit No.
Permit Type: BUILDING ROOFING
JOB ADDRESS: 4-55 14C q1 sreeer
City: Miami Shores
County:
Miami Dade Zip: 33 138
Folio/Parcel#:
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): t1 ,S 011216 MJ 3 . Phone#:
Address: 4 k5 t2/1 s T
City: Mu' 't • fi e, State: 4= — Zip: 33 / 3
Tenant/Lessee Name: Phone#: 3°5- 6.73 -9 2-74
Email: kl d `W ° (, Aso -iZ.. cal> rr►
CONTRACTOR: Company Name: -re... °P� c. i►9 Cra Phone#: 6154 - 0.1.-14:314
Address: vs. 7/ M P /LE • �• �°r
City: eWM .161 13 C.44 State: CI— Zip: 33173
Qualifier Name: ) 1_41W i 4.145. Phone#: VA. • . g
State Certification or Registration #: 5 14, I 4.4p Certificate of Competency #:
Contact Phone#: 154 - & •4? • 1 c, °7 4 Rmail Address: moans rkarn e, 4 rM M . . (-4=3
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ •• (`g r® .00 Square/Linear Footage of Work: L 65
Type of Work: °Addition °Alteration °New °Repair/Replace
Description of Work:
w:9
Color tbru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Re4iew $
°Demolition
CCF $ CO /CC?
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ 1\7)% `y
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
The foregoing instrument was acknowledged before me this g
day of U kJ( , 20 64-, by ilk93J (Kc e. (A)0 012/P—. ,
who is personally known to me or who has produced k�
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires: R.
a--4
Q
Signature \ 1► n
Contractor
The foregoing instrument was acknowledged before me this
day of 2011, by i,nj
who is personally known to me or who has produced FL
i•((' AW,4 Q as identification and who did take an oath.
NOTARY PUBLIC:
Sign: 1Jew
Print: E'r
My Commission Expires:
******** s=ss**** * *** *** * * ** * * ****
APPRO Plans Examiner
Structural Review
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
s PN. Pije < ',4 , i
BRIAN COSGROVE
'
Notary Public - State of Florida
fission #r , E 17978
ring
Clerk
111111111111111111111111111111111111111111111
NOTIC'E OF COMMENCEMENT
A RECORDED COPY MUST BE POSTED ON THE JIM SITE AT TIME OF FIRST OMPECTION
PERMIT NO. to.,1-_L_..-/._.11)mr.7aJAX FOLIO NO.
STATE OF FLORIDA:
COUNTY OF MIAMI-DADTHE UNDERSIGNED hereby gives notice that improvements wifi 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 streeVaddress:
2. Description of improvement a
3. Owner(s) name and add. interest In property:
Name and address of fee simple titleholder: k4
_ , — _..._.
4. Contractor' s name, address • phone number:
etr.. vaic, w.s-r
5. Surety: (Payment bond required by owner from contrctor, if any
Name, address and phone number: N 4.
Nae, address and pfxme number: .. ,
Section 713.13(1X47., Florida
7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Amount of bald S it,__T,..._..„..,
6. Lender's name and address:
. A
1 -76 t.
wi c_ae .,t 11 MAPLE C-4.1.461e.rr
713.13(1)), Florida Statutes. i
8.1n addition to himself, Owners designates the foRowIng person(s) to receive a copy of the Lienor's Notice/el provided kti Section
Name, address and phone number: 14■Eurn
F= t4 2E) 11_ 2 RC) 917 4- .26
011: Bk 28240 P9 4500 Ups)
RECORDED 08/23/2012 11:5720
HARVEY RUVINt CLERK OF COURT
MIAMI—DADE COUNTY FLORIDA
LAST PAGE
Space above reserved ter use of recenfing ottoe
4Apit S14.4.,
1444 G 5
9. Expiration date of this Notice of Commencement
(the explrelon date IS 1 year troon the date at recoraing unfest; a different date is specified)
:NAMING %OWNER: ANY. FAYMENTS MA7DIETYTHE4OWNERATT13-1EENPIRADON COFIE NOTIsEANOF IMItafENTARECONSIDErn
Aicoec f?
IMPROVEMENTS TO WWI PROPERTY. A NCMCE OF CONNENCENENT MUST BE RECORD ED MN:IMMO ON 'ME JOB SITE BEFORE THE
OR RECORDING YOUR NOTICE OF COMMENCEMENT.
FIRST INSPECTION. IF YOU INTEND TO ON1041FNANaM3, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK
Signature(s) of Owners t or Ovenensr Authorized Officer/Director/Partner/Manager
Prepared By /1/601-"Deittt 41lerafssz..
Prepared By
Print Name rl'`3 Print Name
Tito/Office
Title/Wm
STATE OF FLORIDA
couttro OF MIAMI-DADE
The foregoino Instrument woo onlornwieriaed before me this Ca. day off,ApititiCa.
Individually, or CI as
Of Personally known, or arrroduced the following type of 1
Signature of Notary Public
Print Name:
EAU
Under penafties of perjury, I declare that I have read the foregoing and
B F110100,--1-5
that the facts stated in it are true, to the best of my knowledge and belief.
Signattee(s 1) of Owner(s) or Owner(s Authorized Officer/Dkector/Partner
tylelle-SolUEr
By
AILT"rirAs`
$0 e, LOURDES ARMAS
• A Notary Public - State tit Florida
My Comm. Expires Sep 14, 2012
Commission # 00 822401
i!!I P.O. Box 3353, West Palm Beach, FL 334024353
cossTit nasAL TAY coultuToe www.texcollectorpbc.corn Tel: (561) 355 -2272
Sanixg Utts BFI, County
*"LOCATED AT"
8879 MAPLE HILL CT
BOYNTON BEACH, FL 33473 -4855
TYPE OF BUSINESS
OWNER
CERTIFICATION*
RECEIPT =ATE PAID
AMT PAID
BILL #
230039 GGNERAL CONTRACTOR
IRVING KELVIN A
=C1518148
U1 1.43G95$ - QW2e111
$27.50
e4Q142592
This document is valid only when receipted by the Tax Collector's Office.
KATC CONSTRUCTION CORP
KAYO CONSTRUCTION CORP
8879 MAPLE HILL CT
BOYNTON BEACH, FL 33473 -4855
r��,,, ��, r1rr11rre1rr��rrlrrlir ,�„1,1r,[r1r
STATE OF FLORIDA
PALM BEACH COUNTY
2011/2012 LOCAL BUSINESS TAX RECEIPT
LBTR Number: 20100/482
EXPIRES: SEPTEMBER 30, 2012
This receipt does not constitute a franchise,
agreement, permission of authority to perform the
services or operate the business described herein
when a franchise, agreement or other county
commission. state or federal permission of authority
is required by county, state of federal law.
08/23/2012 13 :46 9549211964
ACE UND GRP HWD
PAGE 01/01
ACORD CERTIFICATE OF LIABILITY
*�
INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF
ONLY AND CONFERS NO RIGHTS UPON THE
HOLDER. THIS CERTIFICATE DOES NOT AMEND,
ALTER THE COVERAGE AFFORDED BY THE POLICIES
DATE(MM/DD/YY)
08/23/2012
INFORMATION
CERTIFICATE
EXTEND oR
BELOW.
POLICY NUMBER
D DATE (MM/DDNYI
PRODUCER
Ace Underwriting Group
g p
5305 W. Broward Blvd.
Plantation, FL 33317
954-581-0202
INSURERS AFFORDING COVERAGE
INSURED
KATC Construction Corp
8879 Maple Bill Ct
Boynton Beach, FL 33473
I
INSURERA; Accident Ins Company
INSURER B;
INSURER C:
INSURERD;
INSURER E:
COVERAGES
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
_TYPE OF INBURANGE
POLICY NUMBER
D DATE (MM/DDNYI
DATE IMMIDDNY2
LIMITS
A
GENERAL
uASILITY
COMMERCIAL GENERAL LIABILITY
CPP0003971 -00
07/15/12
07/15/13
EACH OCCURRENCE
$1,0001000
X
FIRE DAMAGE (Any one tire)
$100/000
7 CLAIMS MADE X OCCUR
MED EXP (Any cri0 anew)
$ 5 , 000
PERSONAL a ADV INJURY
$2,000,000
GENERAL AGGREGATE
$1,000,000
GENII AGGREGATE OMIT APPLIES PER
PRODUCTS - COMP /OP AGO
$ 2 , 000, 0 0 0
X POLICY mum.. JEI�CT- LOC
AUTOMOBILE
—
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY
(Per person)
— _
BODILY INJURY
(Per accident)
—
—
PROPERTY DAMAGE
(P& accI ent)
GARAGE
LIABILITY
ANY AUTO
AUTO ONLY • EA ACCIDENT
$
—
OTHER THAN EA ACC
$
AUTO ONLY; AGG
$
EXCESS UABIUTY
EACH OCCURRENCE
$
7
OCCUR E CLAIMS MADE
DEDUCTIBLE
RETENTION $
AGGREGATE
$
$
WORKERS COMPENSATION AND
EMPLOYERS LIABILITY
TORY LIMITS OTH-
ER
E.L EACH ACCIDENT
$
E,L DISEASE • EA EMPLOYEE
$
E.L DISEASE -POLICY LIMIT
$
OTHER
DESCRIPTION OP OPERATIONS /LGCATIONSNENICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Carpentry
CERTIFICATE HOLDER
ADDmONAL INSURED; INSURER LETTER:
Miami Shores Village Building
Dept
10050 NE 2nd Ave
Miami Shores, F1 33138
F#305- 7568972
ACORD 2$-S (7197)
CANCELLATION
SHOULD ANY o1= THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CER IFICA OLDER NAMED TO THE LEFT, HUT FAILURE TO DO GO SHALL
IMPOSE NO ODLIGA
REPRL•SENTA
AUTHORIZED PRE
LIABILI r OF ANY KIND UPON THE INSURER, ITS *M N% OR
0 ACORD CORPORATION 1988
ALEX SINK
STATE OF FLORIDA
CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
le 06 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.
11-19-2010
EFFECTIVE DATE: 11/19/2010 EXPIRATION DATE: 11/18/2012
PERSON: IRVING KELVIN
FEIN: 450545318
BUSINESS NAME AND ADDRESS:
KATC CONSTRUCTION CORP
8879 MAPLE HILL CT
BOYNTON BEACH FL 33473
SCOPES OF BUSINESS OR TRADE:
1- ROOFING CONTRACTOR
2- GENERAL CONTRACTOR
IMPORTANT: Pursuant to Chapter 441. 06{14), F.S., an officer of a corporation who elects exemption from this chapter by tiling a certificate of election under thla
section may not recover benefits or compensation Under this chapter. Pursuant to Chapter 440.06(12), F.B., 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 440.05113), F.S., Notices of election W be exempt and certificates of •
election to he exempt shall be subject to revocation if, at any time after the Bring of the notice or the Issuance of the certificate, the person named on the notice or
certificate op longer meets the requirements of this section for issuance of a certificate, The department shall revoke a certificate at any limo for Ware of the person
named on the certificate to meet the requirements of this section.
QUESTIONS? (850) 413 -1609
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -06
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OP ELECTION TO DE EXEMPT FIZoM FLORIDA
WORKERS' COMPENSATION LAW
EFFECTIVE: 11/19/2010 EXPIRATION DATE: 11/18/2012
PERSON: KELVIN IRVING
FEIN: 45054E318
BUSINESS NAME AND ADDRESS:
XATC coNETTRUCTIoN CORP
8070 MAPLE HILL CT
BOYNTON BEACH, I. 33473
PLEASE GUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
SCOPE OF BUSINESS OR TRADE
1- ROOFING CONTRACTOR 2^ GENERAL CONTRACTOR
F IMPORTANT
O Pursuant to Chapter 440.05(14). F.S., en 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
Rthe notice of election to be exempt.
E Pursuant to Chapter 441L05(13), F.S., Notices of election to be exempt
and certificates of election to he 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 shalt revoke a certificate at any time for failure of the
person named on the certificate to meet the requirements of this
section.
CUT HERE
QUESTIONS? (850) 413 -1609
* Carry bottom portion on the job, keep upper portion for your records.
oWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 09 -08
Planning and Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Issue Date: Not Issued
Expires:Not Issued
Folio Number:1132060140140
Owner's Name: DUSA ACQUISITION LLC
Job Address: 455 91 Street
Miami Shores, FL 33138-
Contractor(s)
KATE CONSTRUCTION CORP
Owner's Phone: (305)496 -7442
Total Square Feet: 0
Total Job Valuation: $ 2,880.00
Planning and Zoning Criteria and Comments
Approved: No
Comments:
Date Denied: 7/10/2012
PLEASE MAKE SURE THERE IS A 40 SQ FT AREA FOR TRASH, CAN NOT BE PART OF THE DRIVEWAY.
1
Planning and Zoning Criteria
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)758 -8972
Issue Date: Not Issued
Expires:Not Issued
Folio Number:1132060140140
Owner's Name: DUSA ACQUISITION LLC
Job Address: 455 91 Street
Miami Shores, FL 33138-
Owner's Phone:
Total Square Feet:
Total Job Valuation:
(305)496 -7442
0
$ 2,880.00
Contractor(s)
KATE CONSTRUCTION CORP
Phone
(954)609 -1076
Primary Contractor
Yes
Planning and Zoning Criteria and Comments
Approved: Yes
Comments:
Date Approved: 7/17/2012: Yes
PLEASE MAKE SURE THERE IS A 40 SQ FT AREA FOR TRASH, CAN NOT BE PART OF THE DRIVEWAY.
7/17/12
NEW PLAN OK
SUBJECT TO COMPLIANCE
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Miami Shores Village
Building Department
WOOD FENCE DETAIL
4x4 Post Spacing
Fences <= 5' high posts spaced at 5'on center maximum
Fences <= 4' high posts spaced at 6 "on center maximum
Fence must not exceed 5' in height
May 2009
4x4 pressure treated
posts embedded 2' into
concrete footing 10°
diameter x 2'deep
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
lx pickets fastened
with two corrosion
resistant fasteners per
connection
ALL wood must be pressure treated
All fasteners must be corrosion resistant
No less than two fasteners in any connection
2x4 horizontal
pressure treated
wood members
with two corrosion
resistant fasteners
per connection
IVliamu Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
REQUIREMENTS FOR FENCE PERMIT
Permit application must be accompanied by:
❑ 2 copies of your survey (not older than 7 years).
❑ If survey Is older than 7 years fill out Survey Affidavit form.
❑ If owner is doing the job, owner must fill and notarize Owner Builders
Disclosure form (This form must be signed and notarized in the building
department only).
❑ Show the proposed size on survey including, required 40 sq ft of garbage
area, location of gates if any, and height (can not exceed 5' ft height).
❑ Include wood or chain link specs form (one with each survey).
❑ $50.00 submittal fee when submitting your permit. --
NOTICE:
ALL OTHER TYPES OF FENCES WHICH DO NOT COMPLY WITH ESPECIFICATIONS
MENTIONED ABOVE, MUST PROVIDE 2 SIGNED AND SEALED ARCHITECTURAL OR
ENGINEERING DESIGNED DRAWINGS, OR MIAMI DADE COUNTY PRODUCT APPROVALS.
Revised on 5/22/2009
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