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FW-13-2420� asl�3 Miami Shores Village Building Department 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: JOB ADDRESS: BUILDING Permit No. OCT 24 2013 20 Master Permit No. XIA ROOFING City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder):P� (0 K_ e oil Phone#: Address: I Yo 31�1 K)P- I! C r City: RA ����YJ2.4 State: , zip: Tenant(l.essee Name: Phone#: Email: CONTRACTOR: Company ,N�ame: r�,�-.' — PERA,--;--e-r Phone#: Address: i'll/C?_`1 ) W) & City:V� I State: ----;Zip: 3 301Z Qualifier Name: � ( � Phone#: be qa % Q ? State Certification or Registration #: Certificate of Competency #:_ Z R S CM1 1 Contact Phone# f I I a% Email Address: Ta�5YPe9&M&aYCa2L (2E' DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ ZOMa ®0 —SouaredinearFootage of Work. Ad Type of Work: OAddition C?Alteration ANep _ DRepair/Replace (]Demolition Description of Work: Color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL. WR NOW DIM It 76. J f Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address Zip 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 EUPROVEMENTS 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 certifined copy of the recorded notice of commencement must be posted at the job site for the fmrst inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be roved fee will be charged Signature Signature — <%2"� Owner or Agent Contractor The foregoing instrument was acknowledged before me this day of 20&-, by Pe-h6n give -r , who is personally known to me or who has produced—D L - As identification and who did take an oath. NOTARY IJ/rlf.% APPROVED BY The foregoing instrument was acknowledged before we this A-- day of .20 -/3, by who isHall kno to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: a f n Print: �V l _ MY WWS= t FF 050710 My Commis sirpitD� EVEi.YN L PASM EXPIRES: Jaiiiary 2, 2018 MY COM ISSN f FF0�710 Baked lieu KwW P� Undue EXPIRES: January 2, 2018 Based Tluu Nmmy Pd¢ Urate whts Awn d Structural Review Clerk (Revised 3/122012)(Revised 07/10/07)(Revised 06/10nM)(Revised 3/15/09) STATE OF (FLORIDA) COUNTY OF (DADE) Miami shores Village Building Department SURVEY AFFIDAVIT 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 The undersigned Affiant, PEV1640 P=j V&PA , does hereby attest that (Property owner) The attached survey, perforated by (Name of surveyor's company) For address: 106 ..-NE i C c -T /q fGPGwu Sykag, —& 3aJ Performed on (date of survey) is an accurate representation of the existing conditions and locations of all structures on the property as of this date. The purpose of this Affidavit is to induce Miami Shores Village to issue a building permit for the property without first providing a survey less than seven (7) years old old. The Affiant, as property owner, further agrees to remove or obtain permits for any structures which now may exist on the property which are not permitted or which may violate zoning or building code regulations. The Affiant further understands that the existence of any such structures may affect final inspections as applicable to this or other permits. ;urther, A t sa th naught C � ve pa Property Owner Signature Property Owner Print Name SWORN TO AND SUBSCRIBED before me this day of �c a20/3 Affiant is personally known to me, produced ?�> L as identification. E116LYN L PASCAL " WcOWNIM# 1`0=0 EXPIRES: January 2-2D18 Notary Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LIC CARD B. COPY OF LOCAL BUSINESS TAX RECEIPT C. ^.COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. P-' COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. __L 1 COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. ! COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ■■rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrsrrrrrrrrrrrrrrr��rrrrrrr�rrrrrrrr� COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME:PEF4kT44e, &Ol)C �Y�LTi BUSINESS ADDRESS: 12.)L3 NL26 _S1 CITY STATE ZIP CODE 336 t2 BUSINESS PHONE: M6 j 'Y% 1 1-T7 FAX NUMBER 80__j Z CELL PHONE�,��� QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: _ 123 S O J 1 i E-MAIL ADDRESS (IF APPLICABLE: fOT-,ES 9Y?B2 -1 `4 X 'T Created on 3H90 BY NUV I RV MAN WOV Client#- 1609919 132FFNCFRY ACORD,,, CERTIFICATE OF LIABILITY INSURANCE DATE(MMMONYYY) 10/23/2013 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(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 CWTEA T BB$T-Oswald Trappe and Company 2200 N Commerce Pkwy, Ste 204 Weston, FL 33326 954 389-1289 ac°NNo Et: 954 389-1289 AICNo): 866-802-8684 E-MAIL ADDRESS. INSURER(S) AFFORDING COVERAGE NAIC a INSURER A: Travelers Property Casualty Ins 36161 INSURED Peralta Inc dba Fences By Peralta 130 W 64th Street INSURER B: INSURER C: PERSONAL &ADV INJURY $1,000,000 Hialeah, FL 33012 INSURER D: E: INSURERF: 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 CONTRACTOR 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. LTR TYPE OF INSURANCE DL INS UBR WVD POLICY NUMBER(420900"MMM/DD POLICY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL UABIUTY CLAIMS -MADE a OCCUR 16602C67645AIND1 7/16/2013 071161201A OCCURRENCE $ 000000 DEAAcHH PREMISES oa:�wrence $100,000 MED EXP (Any one person) $5,000 PERSONAL &ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GENT. AGGREGATE LIMITAPPLIES PER POLICY PR0. LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LUU1ILnY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT accident BODILY INJURY (Per parson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA UABOCCUR AS L3 LI HCLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? El (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC ST.YTA OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space is required) CFRTIFICATF HOI nFR CANCFI I ATInN Miami Shores Village g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S11270765/M10807745 ALYA 07-10-2012 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: 07/06/2012 PERSON: ARIAS FEIN: 451475415 BUSINESS NAME AND ADDRESS: PERALTA INC DBA FENCES BY PERALTA 130 W 64 ST HIALEAH FL 33012 SCOPES OF BUSINESS OR TRADE: 1 FENCE ERECTION -METAL EXPIRATION DATE: 07/06/2014 FRANKLIN SR IMPORTANT. Pursuant to Chapter 440 . 0504f, 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 440.051112), 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 t I 41 JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF FLECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed glow has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 9/17/2012 EXPIRATION DATE: 9/17/2014 PERSON: ARIAS ULISES L FEIN: 451475415 BUSINESS NAME AND ADDRESS: PERALTA INC 130 W 64 ST HIALEAH FL 33012 SCOPES OF BUSINESS OR TRADE: FENCE ERECTION -METAL Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from tht chapter by am a coacate of election under this section may not recover benafit or compensation under tht chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempL. apply only wtthIn the scope of On Wetness or trade fisted an the notice of election to be exempt Pu mod to Chapter 440.05(13). F.S., Notices of election to be exp and certiflcates of election to be exempt shall be subject to revocation if, at any Ina after the firing of the notice or the Issuance of the cera tkate, the person named on the notice Or certificate no Ww meets the requirement of tht section for issuance of a cetttcat?e. The department stall revoke a crertflcate at any time for failure of the person named on the certificate to meet the requirements of this sedan. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 000 { E008 PT �Tfii9A 'NOTA$ILC t ;a Zql # a I�v�auess nI��A�tcry _ �� Iva. <= ESI REQ 007475 i Ttef-��$, VO !0,1' 11111t?h-�t Er�?UFff } THISNO-' A'AL QO1 OTP, X ��y/ P, � a OWNER; 'SSB tYPE OR EUSINE88 AYMEINTtMCE1VEP PERAI,TAINC NIA11C"P�GIA4TY'pUILDINf�'{) I[11 CTOf 128SOb 1 Y TAXECTORt "'Wry 00 /26/42Q13 „ r a This Cal BusinessTax Receiptconfirms Rq pCp 4116,�;ocal Business Tax The Ron isnot @ licene; penml6 or a cerGiiCiflilon of the ho 40' qualrtic ' C�ttl4 irless. Hold copill K i any B9vemmennal or no -SOV arnmemalrapulatarytam 4iequiremeWWhich appiy to the boom r Tia RECEIP7I NO. above f displayed �n ail co"iel re6�r�1 +�lYf�Qa�e lode Sec 8tr-?78+ F Fo ld!1tr8.IniormadoR#-Slt www.miamidade acr[m�caai%attiF' W. e 1 + I a STdBS w RUSIMSS CER,t 92 OO -3 ,4 ZA TA r L in o Shadow Box o Vertical Picket V Board on Board Miami Shores Village Building Department WOOD FENCE DETAIL 4x4 Post Spacing Fences <= 5' high posts spaced at Yon center maximum Fences <= 4' high posts spaced at 6"on center maximum Fence must not exceed Yin height 4x4 pressure treated , posts embedded Tinto concrete footing 10" diameter x 2'deep ALL wood must be pressure treated I All fasteners must be corrosion resistant L No less than two fasteners in any connection 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 1x pickets fastened with two corrosion resistant fasteners per connection 2x4 horizontal pressure treated wood members with two corrosion resistant fasteners per connection OCT 2 4 2013 " Or SCALE: fl -40' I1 1066, STREET PERMIT #: Miami Shores Ulla e APPROVED 8Y DTE ZONING DEPT BLDG DEPT yy SUBJEC7r'f0 CCMPL.IANCE WITH ALL FEDERAL STATE ANL) CCUN'i y AULES AMID REGULATIONS FOR: PETION RIVERA JOB NO: 1008-020 _ FIELD DATE: 08-17--2010 pRop. AOD; 10639 N.E. 11 th COURT, MIAMI SHORES, FL 33138 CERTIFIED: PET10N RIVERA PROSPECT MORTGAGE, LLC. ITS SUCCESSORS AND/OR ASSIGNS. GUARANTY TRUST & TTII E INC. STEWART TITLE GUARANTY COMPANY. LEGAL DESCRIPTION: LOT: 9BLOCK: 2 SUBDWxft MIAMI SHORES ESTATES PLAT BOOK 47 PAGE 58 OF: MIAMI -RADE COUNTY, FLoMU THLSPROPERTYIS MORE THAN 2MILES AWAYFROMTHENAWADE000NFYL4KEBELTAREA. SURVEYOR'S NOTES: 1.j THE SURVEY OF THE PROPERTY SHOWN HEREON IS IN ACCORDANCE WTH THE DESf22IPTION FURNISHED BY CLIENT. 2)&TESS A COMPARISON IS SHONIN, ALL BEARING, ANGLES AND DISTANCES SHOWN HE SAME AS PLAT VALUER 3.) THE LANDS dV HEREON WERE NOT ABSTRACTED FOR EASEMENTS OR OTHER RECORD ENCUMBERANCES NOT SHOWN ON THE PLAT AIS THE SAME, IF ANY MAY NOT BE SHONM ON THE SKETCH. 4.) Ift�DERGRAU D PORTION OF FOOTINGS, FUNDATIONS OR OTHER IMPROVEMENT WERE NOT LOCATED. 5.j FENCES TIES ARE TO THE CENTER UNE OF THE SAME 6.) WALL TIES TO THE FACE OF THE SAME 7.)ELEVATION WHEN SHOWN ARE BASED ON NATIONAL GEODETIC VERTICAL DATUM (1929) UNLESS OTHERIMSE NOTED. 8.) THERE NO ABOVE GROUND ENCROACHMENTS OTHER THAN THOSE SHOWN. 8.fl9W A R�ONPo WRFIO0E PURPOSES ONLY, NOT TO BE USED FOR (FLOOD ZONE INFORMATION) ZONE: -!AE -COMM: 120652pANEL.12086C0306 SUFFIX: L DATE. 9-11-2009 E. 8.00' NOTE ALL WARING HEREON ARE BASED TO THE PLAT BEARING OF ON THE CENTER UNE OF PROPERTY UNE. EASEINENT VIOLATIONS: ❑ YES E NO APPARENT VMIKE ENCROACHMENTS: ❑ YES IN NO COMENTS: AWRE144TIONS: SWK= Sidewalk, CBS= Concrete Bloats Sh ch re, CLF- Chin Link Fence, PL= Property Line, DUE= Dnainage Utliny Easement, IP= Iron Pipe, AIC= Air Conditioner Pad, PO Property Comer, DDH= Drilled Hole, WIF= Wood Fence, RES-- Residence, GL= Clear, RB= Rebar, UE= Utitty Easement, CONIC= Conc. Stab, RAW= Right of Way, DE= Drainage Easement, CIL= Cerner Line, 0= Diameber, TYP= Typical, M= Measured, R= Reowded, ENCR= Encroachment, COMP= Computer, ASPM Asphalt, Nth Nail & Disc., S= Set, FFE= Finish Floor Elevation, O/S= Offset, PIP= Power Pole, OHP-- Overhead Pmeriine, WM- Water Meter. ���ME�SIONS INC. Land Surveying Services OFFICE: 14770 SW 43rd WAY, MIA I F 33185. PHONE: 051512-4225 FAX: (305)_ 512-1914 THE ATTACHED SKETCH OF ABOVE SURVEY OF' DAVID L. FUTCH REGISTERED LAND SURVEYOR # 4843 STATE OF FLORIDA LB # 0=74 SHEET OF?