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FW-14-1929Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-218993 Permit Number: FW -9-14-1929 Scheduled Inspection Date: September 22, 2014 Permit Type•. Fence/Wall Inspector: Rodriguez, Jorge InspectionType: Final Owner: GARCIA, JUAN Work Classification: Wood Fence Job Address: 77 NW 101 Street Miami Shores, FL 33150 - Project: <NONE> Contractor: SAMADA FENCE INC Building Department Comments WOOD FENCE Phone Number Parcel Number 1131010180190 INSPECTOR COMMENTS False Phone: (305)720-6344 September 19, 2014 For Inspections please call: (305)762-4949 Page 7 of 15 Inspector Comments Passed Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. September 19, 2014 For Inspections please call: (305)762-4949 Page 7 of 15 cls Miami Shores Village Building Department QEF 04 14 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING Master Permit No. I -A-' 1 q PERMIT APPLICATION Sub Permit No. QBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: S r - City: Miami Shores County: Miami Dade Zip: 3 31 S 0 Folio/Parcel#: 11310 / 0 i0' d 19 a Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): V k—, C// C 1 C' Phone#: Address: 't u w Si - City: �4, c.w-. + S 1,,4-e- J State: PC3 /J-0Zip: Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Samada Fence, Inc Phone#: 954-559-4355 Address: 110 W 31 ST Cit,. Hialeah State: FL Zip: 33012 Qualifier Name: Sergio M. Samada Phone#: 305-720-6344 State Certification or Registration #: Certificate of Competency #: 11 BS00347 DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: i q Value of Work for this Permit: $ S y Square/Linear Footage of Work:. Y 1 • �" e "'C Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace ❑ Demolition Description of Work: (A) 0 C9 d 4, 4"t, (' 'E! Specify color of color thru the:. Submittal Fee $ Permit Fee $ CCF $ (- e RD CO/CC $ Scanning Fee $ a Radon Fee $ .2,GQ DBPR $ 4-2--X0 Notary $ 0 Technology Fee $ (0 . Tralning/Educatlon Fee $ ! o Go Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ . (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 inspec 'on which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not a proved and j%mirispection fee will be charged. Signatu or AGENT The fore in nstrument was acknowledged before me this day ofV S 20 i 1 by �V CL..vA, who is personally known to me or who has produced D L as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: EMR M J* 17, 2018 WWW.AMINNOTARY.OW Signature CONTRACTOR The foregoing instrument� v was acknowledged before me this dayof yy n7' -VC; V 20 � / by s�-s - Q" is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: oXPIR: J* 17, 218 WWW.AARONNOTAIAIUCIIII xe x�x�*� �xm � mwm�xx�mx��xmwmm�+�x.x��m�x�.�a��xmmm�e�x�xx�xew��+sa�www *.+� �+�a�xxex.meax.mx��x��*��e G� APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Client#: 1452573 132SAMAOFEN ACORD. CERTIFICATE OF LIABILITY INSURANCEDATE(MMMWYYYY) INSRDL LTR TYPE OF INSURANCE 06/05/2014 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 pollcypes) 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 NCONTACT AME. BBS T -Oswald Trlppe and Company W N E4:954 389„1289 c No ; 866-802-8684 2400 N Commerce Pkwy, Ste 204 E-MAIL Weston, FL 33326 ADDRESS: PERSONAL BADV INJURY $1,000,000 954 388-1289 INSURER(S) AFFORDING COVERAGE NAIC @ INSURER A: Travelers Property Casualty Co 25674 PRODUCTS -COMPIOPAGG $1,000,000 INSURED INSURERS: Hartford Fire Insurance Company 19682 Samada Fence Inc INSURER C : Sergio 110 West 31 st Street INSURER D: INSURER E: Hialeah, FL 33012 BODILY INJURY (Per accident) $ Per sedd'IeYMDAMAGE $ INSURER F: COVERAGES CERTIFICATE N1IMRER• APWAIAN NI IMRFD. 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. INSRDL LTR TYPE OF INSURANCE N R UBR D POLICY NUMBER POLICY EFF MM1DDrfYYY) POLICY EXP (MMIDDNYM LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FIOCCUR X PD Ded:250 6602D999165 D610712014 06107/2011. 1 000.000 EEDAACCMHHp OCCURRENCE $1000000'2 PREM SES t aE ence $100,000 MED EXP Any one person $5,000 PERSONAL BADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER POLICY JECOT M LOC PRODUCTS -COMPIOPAGG $1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED ALTOS AUTOS HIRED AUTOS NOAUTOSN-OWNED COMBINED SINGLE LIMIT e ocJdem BODILY INJURY (Pei person) $ BODILY INJURY (Per accident) $ Per sedd'IeYMDAMAGE $ UMBRELLA LIAR EXCESS LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? El (Mandatory in NH) If yea, desonbe under DESCRIPTION OF OPERATIONS below N I A TWO STAT OTH- O ITSER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMB I $ B Surety Bonds 21BSBEB4532 /30/2013 09/30/201 2,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Fence Erection Contractors Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, FL 33138 ACORD 25 (2010105) 1 of 1 #S12467638IM12467597 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 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD LIGO .a�W. JEFF ATWATER CHIEF FINANCIAL OFFICER STATE OF FLORIDA 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: 5/1212014 EXPIRATION DATE: 5/1112016 PERSON: SAMADA SERGIO M FEIN: 204936039 BUSINESS NAME AND ADDRESS: SAMADA FENCE INC 476 E 62 ST HIALEAH FL 33013 SCOPES OF BUSINESS OR TRADE: FENCE INSTALLATION AND REPAIR - Pursuant to Chapter 440.05(14), 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. Pursuantto 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. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 07-12 QUESTIONS? (850)413-1609 Miami shores illa ge Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner _ Workers$ Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore. o� u maybe personally liable for the worker compensation iniuries of any person allowed to work under this permit Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Print Na Signatw State of County of Miami -Dade ) Sworn to and sub ed day of UM; Owner By (SEAL) Type of before me this 20 1 MREM J* 17, Contractor Print Name:_ yeNI O_ 4. Signature: State of Florida) County of Miami -Dade) Sworn t and subsc 'bed before me this day of W -u U , 20_L!t_. By _ 411x' New Avila MMMONW136164 ElltM J* 17. 2MB 1'RRe I of x 4- This property* described .as: The East half (E 1/2) of -.Lot 'Pen (l 0,) t all of Lot Eleven 11 ��.`M1- ( ), 'and West — ' half alf (W 1/2) of- Lot fiwelxze 1.12;- in Block 2, of NAVARRO, ;,.. accordin to the:. Flat " • g .• . . . • .. •..�r: thereof, -as recorded -in _ •' • �►... Plat .Book 12 P . • . • j �. i*9'e.59 >.. 0 7 6 . .. ..o ...... .of. tfie Pulilic 4� Records; of . :a•e•s• tAIrII­TfiDE COUN7'Ys.' FtiOIDA. : • ►� :.. ...- . ;.-. r4,c...:-.-. � /ads •'R r• •�y,•• •• •• NOTE: PAGE.1 OF 2 IS NOT COMPLETE I� o •• ••• •• �" WITHOUT PAGE 2 OF 2 WITH CORRESPONDING 2r 9 /a // • 2 ' , �. = • 00 fff 0' SURVEY . 'o . a. (,v6,a, �Q• � ��11 CJS ! LoGAT•©tel AIAfW1 EAST _bib /So/ do , AaE . To 77c'6E ��+ cG p UT.tJ. • �� � `�G�C=/ d � Cin:, . � tJ"��'' � , ' zAftR •�?✓'1-� rte, �\ • �• � �.J � �`' � • costa' l• � 3r � � C -' 4-6 32x5'2 r •i Ol• o Lu P 0 U. r t'i 2Q to5• N w Ir - 7.s. fn o Q /'3 4 9• Q •a TME CMDLu j 2 i j PcF.rZCH riLE � U � tsoo' sem. E A �a o z Lu v uJ C Iw > ®Lj iO- c W ui4rlc L 2 ® F- Z J 0. Z �U ia)� fM) WEST ` i,,e.onreee,ramee� a' "' 1ky _{/�� 1� s�aymmureeen+m: �G4 '/r -� W :_ ;h of 1� Tedniml3mMardafor lnM ki N r"•,�»� � . -1' 1 cF i - �Y � fn rho Staluef Flu+7ds. ae ouiHnuAs9 '. " ,,., ''� e �� � ..� r ` /� �, �'i�2 i25' � ar-tr•{Ftmtda ae�u,t�v.,wA Caaoios odepred t+y11ro Departrnmd { P 1 -j• __. /' �g ti'+x� r.Y 111 ofAgrioui,wo and Comwu Board of W Wosstond S md Kapp—Ur&oytmnbe+.1887. as mamrdN, �'"�' wo IQ! a t .':, '` A - a -t ';{ '• j�•''-� i° ,sf• 1 �Uretof 'ead is true mp! FLA NAL 4� r ;�$7 r L RH6RiRAlIONIp. AND BY: PROPERTY OF: 'AN C' GAR N.W. i01st Street, Mimi Sliorea., Florida NOTvamwmro,rrnrs'seeax�► e�"M A B©UND_W SIIRVGT 33150 MORM AaoTneortmavaiseai e>: 1 hrrehl certdr that tit• surret rrpir• CANNES ri1N1) (:AiiGld. INC. MAPPMVCOis oS1li;yETORAHp seined hereon meets lhr rrdnrinum technical slandards set faith hs the Board ol.[and Surveyors rn [11311101 6IC17.6 " PROFESSIONAL SURVEYING AND MAPPING Florida Adretnistowhr code Frustum, ,o LANNES & G'ARCIA, 1NC- - Sectlon 4?ZUV, Fla. Stnutet. Ihire air no L.B. #2098 errcroachmerrit. ii -Pelops, rasemrrat FRANCISCO F. FAJARDO PSM 94787 (QUALIFIER) _ 'horning an the Pin. x111101 than » 365 AUmmbra Circle. Suite #C, Coral Gables, Florida 33134- •haven lu rrat PH (305) 666-7909 FAX (305) 442-2530 lertrtesamclata3vahoacom _ .t. tsar sai,vrtnri, 3rmaarnstrn &7 FIFI-1) DA'IT. St:A��: � IIItAWNyI1%` Dime. No Q2 o8/o'Z l 20 um ].37319 I �� QI yit�y/nt� • h�.rnaaief�t� — - -..-c w y� Gi . s",'c. - ¢e.Lx (� bC Q{rHll[� AIC Ak £andltlonMi PM BCA B►wvudCounlyBeard• e1.OB � +pdelW CB QWtSatre CL Cesar C9S t�+naate Stook Slrudw• Gi j a RMkit CIL . CMW Lo o COLIC fHC En<rwdrnt+d LIP Conaeb BE 7 thetrtotru PM aroed �� or bop Enent �t Ito RedNt 1"Aldwq fD rand FLP ,: f FH oiao6'kori f'ip• . f6t - round kon and . f� Fbo Nyjtr • .. •$Efi • • •Semon M•nond ON Not w • 0»dont Qin t>Setd RKord! BnoLt CUL Oradndlllibl Yatkal d,C •Spt • • • • SeraeeR . PB PNtfl•oM PC PalatolCnrnks• FLbu1 p Pp PCC Pow olCortpound corn Po " PUt • • • • • 690699 • • �� 0 • $rl kon ; Pr•P•+hLG+� PIs Potedof �tbatne PtMI Poddof0auraadntnp PAC Pap Potnl�ttt�ii� � fi • i.. Stde•+lk� i UP My PobCurraper� WN ib'abfLtnta A C•nkel l{ayM • • • • • • iPi • • tRaGt f • T ton"A LAW 410 U" PT AE Pokdd• villo • wo•••tiWaMelei' • Or$ pthU•• •• •••• •• ' a) AN • • •onmhmerts •••••• :• shwon hereat are of apparent Walrus, Legal . r Fence ownership ownerst Fof-fenM not determined. by visual means;; b) Ibe issue of this survey is atdy for the exclusive and • certiticaUon. Any other Intended use w!9 require written -approval from the cerUpersonse parties or Insiilrit�ons shim In the fylrtg surveyor or firm; c) Cade restrictions and title search are not reflected on this survey. d) Underground uti as and encroadLrrfertts, U any, not located. e) The ft*d information shown hereon does not imply that the referenced property will or will not be free from ood damage and does not create liability on the part of the itrmm, any officer or employee thereof, for any damage n(hat�8 or results from reliance on paid Information. f} The lards d implied. d hereon "'Ore,surveyed per the legal description and no claims as to ownership or are made or kftplied. p matters of title NOTE: PAGE 2 OF 2 IS NOT -COMPLETE WITHOUT PAGE I OF 2 WITH CORRESPONDING SURQEy. FLOOD ON � X - t:�00D.tM�ORIlAA77n �• • Community Number. 1211652 Panel Number /-Map : No .: I-098 Suffix: L F.M. Index Date: 9-1='019::' , Base Elevation: Not Available Bearings, It any shown based on r06li'rED '`T�'Gvle f'l?"'/�!(reference) �EHiIEi>eD Tor ' — w� LAW OFFICES OF ISAAC BENMERGUI, P.A., OLD REPUBLIC NATIONAL TITLE INSURANCE COMpANy, JJANN cRczA, NORM=Ma'G`AGE THHELxr 10Th T XAr4%'PEAI .----7'..ATIIDII It-klSSIG1vs, AS • AttO1AdOARYStmvev ' .• t�Y�7lCatltdts su" conforms to the fiAkmmon Technical Surninds for Land Sumoyhi8 In tie Slate of FFbrida; as oudh*d in Ries 3J-17,(FloddaAds o Cadej -adopted by the Oapart em �rdOfPae�� Services. • klaPpars in 3epfe� ,1g� em�ar�ed. AoauaMto Chapter47ZG27 of the thaw 8 •Mad Is the and correct m3+ edge amt belld. • mArROi'�ssloanL et aErttsrRAnaR ao��� PROPERTY OF: �...- ..Ael,f lwrvaLpuranmurnles•mnrtM� __ C Z ''�N W. 101st St wet ' armnietMtaairaLRnt��nt.OF . FLGF=LMUjWSURVEMNW A QUNDARv. sum m, 3315E MANVL " ,► #A a * •,► npt.•nrad LANNES AND GARCIA INC. . Aason Moab on arm bcou f a , at•trduds -1 fmBl hY ON Both of Land 1 ft—W, In doptir •loly.1 t b IA L.B. 92098 _......._.V3=65 — -- . _ — ft6 AdrNnbpok "S. purnom (o S"llonESS010%r'''te• •'•CANNES & GARCIA, INC m•Mts, ar•d•p•. •k•apoMt• uppnrinFRANCISCO F- FX%Mo PSM #4787 (QUAUFIER) Alhambra Circle, srdfe #C, COral Gables, Rodda 33134, PH (305) Nil 7W9 FAX (305) 442-2830 . _--- datalvatroo�n r1ELDiu1FE SCALE I f "BV DRAWING NO n.►aa:�mve,rart,atQa+,;m./ �% 2—oB�2 �---�. ._..,. 137319 - 256130 2 0, w >x 0 0 0 0 P4 o Shadow Box o Vertical Picket y Board on Board May 2009 Miami shores.ViRase BuildinC-9-piaktibldht .2nd Avdnue Miami Shorgs; Florida 33138 TOJ: (305) 79t,M04 Sad: 4,'305) 7=$972 WOOD FENCE DETAIL 4x4 Post Spacing Fences <= 5' high posts spaced at Ton center maximum Fences <= 4' high posts spaced at 6"on center maximum Fence must not exceed Yin height 4x4 pressure treated .� posts embedded 2'into 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 0000.. 0000.. .. 0000 1x pickets fastened with two corrosion resistant fasteners per connection 2x4 horizontal pressure treated wood members with two corrosion resistant fasteners per connection 0000.. . 0000.. .0000. 0006. . . 00 0 0. 0000.• •0000. .0000.