FW-13-1022Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 191783
Permit Number: FW -5 -13 -1022
Scheduled Inspection Date: May 24, 2013
Inspector: Bruhn, Norman
Owner: ADAMS, PETEY
Job Address: 9009 NE 4 Avenue
Miami Shores, FL 33138 -0000
Project <NONE>
Contractor: ABURI LLC
Permit Type: Fence/Wall
Inspection Type: Final
Work Classification: Wood Fence
Phone Number (786)683 -6029
Parcel Number 1132060460050
Phone: (954)548 -1548
Building Department Comments
INSTALL FENCE AND GATE
Infractio Passed Comments
INSPECTOR COMMENTS
False
Passed
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- 191222. 3 horizontal members
are required. NB
May 24, 2013
For Inspections please call: (305)762 -4949
Page 17 of 19
PERMIT #FIA f , j— /002,2
CONTRACTOR:,8Ur / Le,,C. ,
SUBMITTAL DATE: , '10 0 - /��
ADDRESS:9/ 4)i % 4Ve (2J
NAME: ,-/e_y / S, ,r 3 -
,
RESUBMITAL DATES:
&di. inciolinneni.
FIRE
PROJECT TYPE: ,i-e°rzee and
re, 0/0
06_.
ZONING t /6/43
STRUCTURAL
IMPACT FEES
ELECTRICAL
HRSIDERM
PLUMBING
NOC
MECHANICAL
11
BLDG
Miami Shores Village
Building Department
90050 N.$.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit No.
Master Permit No. P t 1"3
Permit Type: BUILDING ROOFING
JOB ADDRESS: LC-: r i - E ' °
City: Miami Shores ounty: Miami Dade Zip: c3,§ (1 R-
Folio/Pareel#:
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): / Phone#: '78p • c� 4
Address: A � ,`S h x'44 41Y- ti —(O
City:. -40re4 f4C
Tenant/Lessee Name: 11i, -,
Email:
State: Zip: c�vd-
Phone#: a 5. '
t C9 -7r- S --00 V
1-L'C- CONTRACT R: Company Name: " tr �? g Phone #: Aft,
Address:
City:
Qualifier Name:
State Certification or Regi
Contact Phone#:
DESIGNER: Architect/Engineer:
i Value of Work for this Permit: $ ®° Q
Type of Work: OAddition � � �a�► ONew
Description of Work:
Square/Linear Footage of Work:
ORepair/Re,ace
ODemolition
Color thru tile:
* * * ** * * * * ** ** * * * * * * *,x�xa�a�x��x******* ** **F gr** *** ** r�►** **w�xr�+�a� *>�v��xa��xa�a�,x�x� *** **** * ****
Submittal Feed L . Permit Fee $ /0(9
CCF $
Scanning Fee $ Radon Fee $ DBPR $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
CO /CC $
Bond $
TOTAL FEE NOW DUE $
if 6()
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
3 >
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 Fi .RCTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AHIDAVIT: 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
Omer or Agent
The foregoing instrument was acknowledged before me this
day of , 20 by Pe+t
}4d s
who is personally known to me or who has produced FL- D L-
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: Phvf it (PS Sbb1 rN
My Commission Expires:
SlQ.l tab
l�o
* * * * * * * * * * * * * * * * * * * * * **
APPROVED BY
"/AC
PHYUJS A. S UU NM
Notary Pubik - Statt otibrdu
*Comm. Expires May 21, 2016
.l.• * * **
1,71',10% QordadT iou h Wmondfia aryllwi.
Signature
Contra
The foregoing instrument was acknowledged before me this
day of , 20 43, by./.un PYl0 @ who is personal y known to me or who has produced
as identification and who did take an oath.
NOTARY Pili3L.W-W:
* * * * * * ** **
Structural Review
R
(Revised 3 /12/2125(Revi
•
i7 /10/07)(Revised 06 /10t2009)(Revised 3/15/09)
ssion Expires: l& q/ a O l (..p
Clerk
DBPR - 1IAGOME, CLEMENCE KUDJO; Doing Business As: ABURI LLC, Certified ... Page 1 of 1
Licensee Details
Licensee Information
Name:
Main Address:
County:
License Mailing:
LicenseLocation:
License Information
License Type:
Rank:
License Number:
Status:
Licensure Date:
Expires:
Special Qualifications
Construction Business
FLA) 13- 10
FIAGOME, CLEMENCE KUDJO (Primary Name)
ABURI LLC (DBA Name)
P.O. BOX 22271
FORT LAUDERDALE Florida 33335
BROWARD
Certified General Contractor
Cert General
CGC1512890
Current,Active
02/09/2007
08/31/2014
Qualification Effective
10/24/2008
View Related License Information
View License Complaint
9:33:55 AM 5/10/2013
1940 North Monroe Street, Tallahassee FL 32399 :: Email: Customer Contact Center :: Customer Contact Center: 850.487.1395
The State of Florida is an AA /EEO employer. Copvrioht 2007 -2010 State of Florida, Privacy Statement
Under Florida law, email addresses are public records. If you do not want your email address released in response to a public - records request, do
not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact
850.487.1395. *Pursuant to Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must
provide the Department with an email address if they have one, The emaiis provided may be used for official communication with the licensee.
However email addresses are public record. If you do not wish to supply a personal address, please provide the Department with an email address
which can be made available to the public. Please see our Chapter 455 page to determine if you are affected by this change.
https:// www. myfloridalicense .com/LicenseDetail. asp ?SID= &id= 14F101B5F657B48F11D... 5/10/2013
Property Information:
Folio
11- 3206 - 046 -0050
Property Address
9009 NE4AVERD9009
Owner Name(s)
PETEY L ADAMS
Mailing Address
9009 NE 4 AVE RD #9009
MIAMI SHORES FL
33138 -3182
Primary Zone
3000 MULTI - FAMILY - GENERAL
Use Code
0007 CONDOMINIUM - RESIDENTIAL
Beds/Baths/Half
2/2/0
Floors
0
Living Units
Adj. Sq. Footage
954
Lot Size
Year Built
1974
Legal Description
SHORES VILLAS CONDO BLDG A
UNIT 9009
UNDIV 1/88% INT IN COMMON
ELEMENTS
CLERKS FILES 74R- 185949 &
74R - 263202
Assessment Information:
Current Previous
Year
2012
2011
Land Value
$0
$0
Building Value
$0
so
Market Value
$64,050
$85,400
Assessed Value
$64,050
$85,400
Exemption Information:
Current Previous
Year
2012
2011
Homestead
$0
$0
2nd Homestead
$0
$0
Senior
$0
Veteran Disability
$0
$0
Civilian Disability
$o
$0
Widower)
$0
Disclaimer:
age 1 of 1
MIAMI -DADE COUNTY
OFFICE OF THE PROPERTY APPRAISER
PROPERTY SEARCH SUMMARY REPORT
Carlos Lopez- Cantera
Property Appraiser
Aerial Photography 2012
Taxable Value Information:
Current Previous
Year
2012
2011
Exemption/Taxable
Exemption/Taxable
County
$0/$64,050
$0/$85,400
School Board
$0/$64,050
$0/$85,400
City
$0/$64,050
$0/$85,400
Regional
$0/$64,050
$0/$85,400
Sale Information:
Date
Amount
OR Book -Page
Qualification Code
4/1994
$50,000
16324 -1589
Sales which are qualified
12/1975
$40,500
00000 -0000
Sales which are qualified
The Office of the Property Appraiser and Miami -Dade County are continually editing and updating the tax roll and GIS data to reflect the latest property information
and GIS positional accuracy. No warranties, expressed or implied, are provided for data and the positional or thematic accuracy of the data herein, its use, or its
interpretation. Although this website is periodically updated, this information may not reflect the data currently on file at Miami -Dade County's systems of record. The
Property Appraiser and Miami -Dade County assumes no liability either for any errors, omissions, or inaccuracies in the information provided regardless of the cause
of such or for any decision made, action taken, or action not taken by the user in reliance upon any information provided herein. See Miami -Dade County full
disclaimer and User Agreement at http:// www. miamidade .gov/info /disclaimer.asp.
Property information Inquiries, comments, and suggestions email: pawebmail @miamidade.gov
GIS inquiries, comments, and suggestions email: gis @miamidade.gov Generated on: Fri May 10 2013
http:// gisweb. miamidade .gov/PropertySearch/printMap.htm 5/10/2013
JEFF ATWATER
CHIEF FINANCIAL OFFICER
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
06 -08 -2012
* * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * *
CONSTRUCTION INDUSTRY EXEMPTION
This certifies that the individual fisted below has elected to be exempt from Florida Workers' Co tts 'on Iavv.
EFFECTIVE DATE 06/08/2012 EXPIRATION DATE 06/08/2014
PERSON: FIAGOME CLEMENCE K
FEIN: 800224512
BUSINESS NAME AND ADDRESS:
ABURI LLC
P 0 BOX 22271
FORT LAUDERDALE FL 33338
SCOPES OF BUSINESS OR TRADE
1- CONSTRUCTION 2- CERTIFIED GENERAL CONTRACTOR
IMPORTANT: Potsdam to Chapter 440. 05(14), F.S., an officer of a corporation who elects exemption from this ch
section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.06(12) F.S., Coral Istrtea the
scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.0503),„ :F.s at __ .._
election to be exempt shalt be subject to revocation if, et any time after the filing of the notice or the a of aft 00r#ificfte: 100 per aob a u or
certificate no longer meets the requirements of this section for issuance of a certificate. The department seas revoko fartiffui1n at any thetritir refine of the person
named on the certificate to meet the requirements of this section. QUESTIONS? (850) 41
DWC-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 OP ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW
EFFECTIVE: 00/08/2012 EXPIRATION DATE: 08/08/2014
PERSON: CLEMENCE K FIAGOME
FEIN: 800224612
BUSINESS NAME AND ADDRESS:
ABURI LLC
P 0 BOX 22271
FORT LAUDERDALE, FL 33335
SCOPE OF BUSINESS OR TRADE:
1- CONSTRUCTION 2- CERTIFIED GENERAL CONTRACTOR
IMPORTANT
OF Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who
elects exemption from `this chaPer by filing a certificate of electior
L under this section may not recover benefits or compensation under -ti
D 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
E the notice of election to be exempt.
R
E Pursuant to Chapter 440.05(13), F.S., Notices of election; to be exem
and certificates of election to be exempt shall be subject to revocai
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
the requirements of this section for issuance of a certificate. The
department Mall revoke a certificate at any time for failure of the
person named on the certificate to meet the requirements of this
section. y f
QUESTIONS? 18501 413-1
CUT HERE
* Carry bottom portion on the Job, keep upper portion for your
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT
115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000
VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013
DBA:
Business Name: ABURI LLC
Receipt #:GENE AFL CONTRACTOR
Business Type:
Owner Name: CLEMENCE KUDJO FIAGOME Business Opened:12/02/2008
Business Location: 1021 SW 15 AVENUE State /CountylCert/Reg:CGC1512890
FT LAUDERDALE Exemption Code:
Business Phone:
Rooms
Seats
Employees
2
Machines
Professionals
For Vending Business Only
Number of Machines:
Vending Type:
Tax Amount
Transfer Fee
NSF Fee
Penalty
Prior Years
Collection Cost
Total Paid
27.00
0.00
0.00
0.00
0.00
0.00
27.00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is
non - regulatory in nature. You must meet all County and /or Municipality planning
WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when
the business is sold, business name has changed or you have moved the
business Location. This receipt does not indicate that the business is legal or that
it is in compliance with State or local laws and regulations.
Malting Address:
CLEMENCE KUDJO FIAGOME
1021 SW 15 AVENUE
FORT LAUDERDALE, FL 33312
Receipt *035 -11- 00008429
Paid 09/20/2012 27.00
*�t
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PRPFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399 -0783
FIAGO R
ME, CLEMENCE UDJO
ABURI BOX P. 22271
FORT LAUDERDALE FL 33335
Congratulations) With this license you become one of the nearly one million
Floridians licensed by the Department of Business and Professional Regulation.
Our professionals and businesses range from architects to yacht brokers, from
boxers to barbeque restaurants, and they keep Florida's economy strong.
Every day we work to improve the way we do business in order to serve you belt
For Information about our services, please log onto www.myfloridallcense.com.
Them you can find more information about our divisions and the regulations that
impact you, subscribe to department newsletters and leam more about the
Department's initiatives.
Our mission at the Department is: License Efficiently, Regulate Fairly. We
constantly strive to serve you better so that you can serve your customers.
Thank you for doing business in Florida, and congratulations on your new license!
THIS DOL., PilEN T F AS A COL LOCi "i B'AC C,
BATCH NUM
ABUR1.1 OP ID: P4
CERTIFICATE OF LIABILITY INSURANCE I DATE (MM+DDIYYYY)
05/16/2013
THIS CERTIFICATE 15 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(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
Insurance Market Place
2801 SW College Rd, Suite 3
Ocala, FL 34474
IMP
Phone: 352 - 237 =2700
Fax: 352= 2375884
PHONE
Na Extk
ADDRESS:
FAX
(ANC. No):
INSURED
Aburi, LLC
PO Box 22271
Ft Lauderdale, FL 33335
INSURER(S) AFFORDING COVERAGE
INSURER A :Accident Insurance Company
INSUREER B :
N+IC
INSURER C :
INSURER D :
INSURER E
INSURER F
COVERAGES u I I IrIVAI c r4umocr : •-- -•----- --
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 POUCIES. OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTRFI
TYPE OF INSURANCE
ADM SR
W VD
POLICY NUMBER
IMMIDDIYYYYYYI
POLICY MOP
UMITS
A►
CPP000066301
01/27/2013
01/27/2014
EACH OCCURRENCE
$ 1,000,000
GENERAL
X
LIABILITY
COMMERCIAL GENERAL LU181LfIY
.RAMAaErORENTED
PREMISES (Ea oaanrerlce)
$ 100,000
MED EXP (Any one person)
$ 5,000
CLAIMS -MADE
X
OCCUR
PERSONAL & ADV INJURY
$ 1,000,000
$ 2,000,000
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGO
$ 2,000,000
$
GENT, AGGREGATE LIMIT APPLIES PER
POLICY Ti TA: P LOC
.
Cie INdEDtSINGLE LIMIT
AUTOMOBILE
—
LIABILITY
BODILY INJURY (Per person)
$
ANY AUTO
O8NED
HIRED AUTOS
--
—
_
SCHEDULED
AUT
NON -OWNED
AUTOS
BODILY INJURY (Per accident)
$
PROPERTY accident)
$
$
`
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
UMBRELLA LIAR
EXCESS LIAR
AGGREGATE
$
$
1 RETENTION $
WORKER$
DED
COMPENSATION
N f A
TORY TL TUUS T ER
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y
D (Mandatory In nd OCCLUDED?
If vea, describe under
OF OPERATIONS below
EL EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
L DISEASE -PO LIMB
E LICY
$
*
DESCRIPTION
DESCRIPTION
General
OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, B more space Is reqired)
Contractor
CERTIFICATE HOLDER
Town of Miami Shores
Building Department
10050 NE 2nd Avenue
Miami Shores, FL 33138
ACORD 25 (2010106)
TOWNMIA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTOO REPRESENTATIVE
�r
T
IMP
VL/`•aCl `J
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The ACORD name and logo are registered marks of ACORD