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FW-13-1664Miami 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 BUILDING PERMIT APPLICATION Permit Type: BUILDING C A1,a7(T qUK' - - - - FBC 20 Permit No. / "Master Permit No4�9e / w- ROOFING JOB ADDRESS: l (" (. S " -e' City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO X- Flood Zone: OWNER: Name (Fee Simple Titleholder): -'�'Oyl o Phone#: Address: 16 6 N -� :� ii S4-mt.y City: State:t�— Zip: 3i Tenant/Lessee Name: Phone#: Email: ---yy` o a(2N o froA e--4 Lo CONTRACTOR: Company Name: � Phone #: Address: `.l�Z �� City:Stater Zip: QualifierName: i�'C��� Phone#: State Certification or Registration #: Contact Phone#: DESIGNER: Architect/Engineer. Certificate of Competency ##: 1 .5 '6-- Address: 3 6`Fi—�VPiQi �- ` vV1, Value of Work for this Permit: Square/Linear Footage of Work: Type of Work: ❑Addition Description of ❑Alteration ❑New Color thru tile: M Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ ❑Demolition 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 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 ap roved and a reinspection fee will be charged. Signature Signature -- O er or Agent Contractor The foregoin instrument was acknow edged before me this 1 The foregoing instrument was acknowledged before me this E RU day of 3� / , 20 !a, by'�®G^s day of �4�17� , 20 a�� by �t�i�� , who is personally known to me or who has produced X As identification and who did take an oath. �Tnm ♦ TM) "V Till V! - who is personally known to me or who has produced as identification and who did take an oath. -- • - rrT..r tom_ Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk ACORU® CERTIFICATE OF LIABILITY INSURANCE DA -mommas""' 07/20/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGIirS 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 AODTIIONAL INSURED, the pollcy(ies) 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 Hsu of such endamemenl(sj. PRODUCER =ACT Tony Iglesias ROYALTY INSURANCE GROUP 8846 SW 129 TERR 2nd Floor PHONE 305-23;1-5333 FAX n, 1305-359-5117 ADDDRESS. ager .cam AFT IG COVERAGE NAS NI EACH OCCURRENCE $ 500,000 MIAMI FL 33176 I SURER A: Granada 0 UNSURED INSURER B: SOUTH FLORIDA FABRICATION AND FENCING INC. INSURER C: 8838 SW 129 TERR. 2ND FLOOR INSURER D: INSURER E: AUTOMOBILE LIABL" ANY AUTO ALL AUTSCHEDULEDfos HIRED AUTOS AUTOS SURER F: Lfmrrd FL 33176 (Ke1'1�:7_Cr7 �3Ti;I .a r =I .I ; : :4, - a P 0 , , I „ I: tlr. 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 POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF H ANCE 711E EXPIRATION DATE THEREOF, NOTE WILL BE DELIVERED IN POLICY t, UMM POLICY EFF EXP Lam A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR 0185FL00043703 03/04/2013 03/04/2014 EACH OCCURRENCE $ 500,000 fISES $ 100,000 MED EXP ( ow person) $ 5,000 PERSON g ADV KUW $ 500,000 GENERA. AGGREGATE $ 500,00 GEHL AGGREGATE LOW APPLIES PER POLICYFI PRO Loc PRODUCTS - COMPIOP AGG $ 500.000 $ AUTOMOBILE LIABL" ANY AUTO ALL AUTSCHEDULEDfos HIRED AUTOS AUTOS COMBINED SINGLE LINT BI $ BODILY INJURY (Per person) $ BODILY INJURY (Per mcidert) $ PROP�ERdTI�' QAMAGE $ $ rrua�m r e LABHCLARASMADE EXCESS LIAB OCCUR EACH OCCURRENCE S AGGREGATE $ DID I I RETENTION $ $ VIORIUM COrIPENSAIM AND EMPLOYEW L1/UBLRY YIN ANY PROPRIETOR A CUTNE® OFFtCEPRAEMBER EXCLUDED? ( fT In fin► Iyes, desalbe under DESCIWON OF OPERATIONS balsa• NIA VC STATIM OTH- TOW LMTS ER EL EACH ACCIDENT $ E.L. DISEASE -EA EIMOYU $ EL DISEASE - POLICY LIMB $ DESCRIPTION OF OPERAT[ONS I LOCATUTAS I VEHICLES (AtleM ACORD 10%MMunal Rmnaft Sctm&ft B more apm is rte) CERTIFICATE HOLDER r -A MMI r ATICIN MIAMI SHORES VILLAGE SHOULD ANY OF 7HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 100.50 NE 2 AVE. 711E EXPIRATION DATE THEREOF, NOTE WILL BE DELIVERED IN ACCORDANCE WITH THE POLY PROVISIONS. MIAMI SHORES, FL. 33138 AUTHO ACORD 25 (2011IMS) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD .EFF ATWATER CHIEF FINANCIAI.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: 3/5/2013 EXPIRATION DATE: 3/512015 PERSON: IGLESIAS ANTONIO I FEIN: 460805816 BUSINESS NAME AND ADDRESS: SOUTH FLORIDA FABRICATIO 8838 SW 129 TERR. MIAMI FL 33176 SCOPES OF BUSINESS OR TRADE: FENCE INSTALLATION AND REPAIR- Pursuard to Chapter 440.05(14), F.S., an o1ikoar of a corporation who elects exemption from this chapter by flitg a certificate of election under this section a" not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempL.. apply only within the scope of the business or bade meted on the mice 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 meals 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 s to meet the requk mrrents of tins section. DFS-F24N4G-252 CERTIFICATE OF ELECTION TO BE EXBAPT REVISED 07-12 QUESTIONS? (850)413-11349 TQ ConsUucfion Trades Qualifying Board BUSINESSCERTIFICATE OF GOMPETENCY -� a SOUTH FLORIDA FABRICATION /111WE 1CM INC QUALIFYING TRADE(S) 0018 FENCE p� �eeomn ���� �.eovt�v�aroor�nt rRAL 1477O SW did SCAM 11=2Q JOO 1209-028 mi16W ii�R 331iS. F�,O�A4E09-2�20t2 0 310NS INCE E; (UM512-4226 TYPE�PHaJ>Efa MONE. Surveying Services Rk (31812-0814 BOUNUff SURVEY Fte JULIO A. ABARCA UM BESCAMM A RESUBDIVISION OF VW.Ap% 166 NX 48th SIREEF, MIAMI SHORES, FL 331.0 M. 6 _ UML.• 2 _ OCKZ OF BONMAR PARE $i�//) NATUM. 42 ppm MIAMI-DADE -_-- � NX 0 STHET S � ' 75.00' Tota{ RIW j 21 Asphaft 81adi2 W Cr7 r T� ® �3t L <. 55'< ONESTORYCOS RESMOWEN ani ' 21.5tt N 33' 134' 32 . $ G rete - \� AIC U 14.00' rrau. .Trc 0 C_ F^ Ulu { r P s�aTEs�; -tjSHOM FEEREDNIISINAOWRDANCE HTHTHE OESCR}PiIONF BYaJear- 21ARETIH48.ESff SANESAODdN�JG4H�(ALLBfi0.RlRti, AFRiI.ESAA®IYfirARt�SSi AS PLAT VALUES. S ITHELHJ�9�TPANHl 3H A�TABSIRACfEDfIXtEASE E4W R'g-ER REQ NDT 5HDYW�+I TFPLAT ANOTHESAB�',fFANY NAY NOTBESHOMONTHESKErm 4 UNtt Lo&4;RiH=0F FOOTI�=,FkVAT1OMOROTfM&*4R YEMM V1�1iE NO7 LOC7{IEO. S.IFENGESTfE$ ARETOTHEf�'dTER LK+ff W T+e SMS Vu11.T¢S TOTHP FAL OF TI$SAMIr. aT3FEA74DRAKS4Et58fR2N06(5MElIDKVYEi9fRTBASED Ot7ld IM gMESSO CtI"�NTS OTHSTNT�9 SHOIAK lots WoCk2 P j CLrR IDJ.P.UY — — - CER7777ED TO: JULIO A. ABARCA. PREFERRED MORTGAGE LENDERS GROUP. INC- ITS SUCCESSORS AND/OR ASSIGNS GUARANTY )RUST d TRIS, WC_ FIDELITY NATIONAL TOLE INSURANCE COMPANY. AVOREVA47MM. SN@C= 58dewa9�, CBS , Lt=a OUJq E m8e m. W- CT Poe, Fenoe, Fi.= +LUie, G ad CrvaaBe tlmmt Ei»t. - D R P4�a, i -Akt IImo�Pao pJf.Tplmlp amet. Daft. km Re Hae. 5\W4 Fl. RSS9 R Ecm tri G CL iJmr :Rs iNn ReLm. � UffiY Ems, COt�.Ostc Ste, RAW f6yaalYatrK tkeEa�+tma. C. Ce'm Clea. fh Q�anela 1'YW TSF Cd= EAeswrea R+Ratmaae, E+� SMn=mamt COUP- Oaryk t A$PIF+A C Ids MV 8 L49G, SE+.m S-NM- ftM Hoa0%0&ePP- P. Pe OHPP e{,Y'l,, vam Fmw , Fab. ^c6=PE�1=LEamlem MaavemlaoeEat FdE- Ea�rn4 B.C=ffiadcCanrer. a C=Pa�tat :,mase. f: QgFaJ+W. I Yl I'J^hc +Cm+t+�an (FIGQBY4A$ T� roam.Deme=saanwr�m+sr.rrmc:�s.o�,�,Rm,.smmm+mm, ZONE: X CCI:'?D62 a� I2ft86CO302WFFU ; L DATE.9-I I-20D%ASE _NIA NOTF—DErERM'4ATtONOFFLODDZMEUNESV4BVEBASMONSQPIMOFFHMMWUSTEDAWW amma� mo '+�m�s�ra.wer�s�.a�am .an.°timm ND�fEALiREAt�lti Axeeaa�Totr��tT � ��li ��� t,�(%�°� �Taer�s� — 13YES mmo DAA L. REGfSTEim LAND SURVEYOR #4843 OYES ®NA STATE OF FLORIDA L6# 000SBT4 _____ NOTE NOT VALID UlaM- eutcm` 4 we 4 B -C. i. CSS Planer 11.OU 14.55 11.33' 10 c 28.45' 81adi2 W Cr7 r T� ® �3t L <. 55'< ONESTORYCOS RESMOWEN ani ' 21.5tt N 33' 134' 32 . $ G rete - \� AIC U 14.00' rrau. .Trc 0 C_ F^ Ulu { r P s�aTEs�; -tjSHOM FEEREDNIISINAOWRDANCE HTHTHE OESCR}PiIONF BYaJear- 21ARETIH48.ESff SANESAODdN�JG4H�(ALLBfi0.RlRti, AFRiI.ESAA®IYfirARt�SSi AS PLAT VALUES. S ITHELHJ�9�TPANHl 3H A�TABSIRACfEDfIXtEASE E4W R'g-ER REQ NDT 5HDYW�+I TFPLAT ANOTHESAB�',fFANY NAY NOTBESHOMONTHESKErm 4 UNtt Lo&4;RiH=0F FOOTI�=,FkVAT1OMOROTfM&*4R YEMM V1�1iE NO7 LOC7{IEO. S.IFENGESTfE$ ARETOTHEf�'dTER LK+ff W T+e SMS Vu11.T¢S TOTHP FAL OF TI$SAMIr. aT3FEA74DRAKS4Et58fR2N06(5MElIDKVYEi9fRTBASED Ot7ld IM gMESSO CtI"�NTS OTHSTNT�9 SHOIAK lots WoCk2 P j CLrR IDJ.P.UY — — - CER7777ED TO: JULIO A. ABARCA. PREFERRED MORTGAGE LENDERS GROUP. INC- ITS SUCCESSORS AND/OR ASSIGNS GUARANTY )RUST d TRIS, WC_ FIDELITY NATIONAL TOLE INSURANCE COMPANY. AVOREVA47MM. SN@C= 58dewa9�, CBS , Lt=a OUJq E m8e m. W- CT Poe, Fenoe, Fi.= +LUie, G ad CrvaaBe tlmmt Ei»t. - D R P4�a, i -Akt IImo�Pao pJf.Tplmlp amet. Daft. km Re Hae. 5\W4 Fl. RSS9 R Ecm tri G CL iJmr :Rs iNn ReLm. � UffiY Ems, COt�.Ostc Ste, RAW f6yaalYatrK tkeEa�+tma. C. Ce'm Clea. fh Q�anela 1'YW TSF Cd= EAeswrea R+Ratmaae, E+� SMn=mamt COUP- Oaryk t A$PIF+A C Ids MV 8 L49G, SE+.m S-NM- ftM Hoa0%0&ePP- P. Pe OHPP e{,Y'l,, vam Fmw , Fab. ^c6=PE�1=LEamlem MaavemlaoeEat FdE- Ea�rn4 B.C=ffiadcCanrer. a C=Pa�tat :,mase. f: QgFaJ+W. I Yl I'J^hc +Cm+t+�an (FIGQBY4A$ T� roam.Deme=saanwr�m+sr.rrmc:�s.o�,�,Rm,.smmm+mm, ZONE: X CCI:'?D62 a� I2ft86CO302WFFU ; L DATE.9-I I-20D%ASE _NIA NOTF—DErERM'4ATtONOFFLODDZMEUNESV4BVEBASMONSQPIMOFFHMMWUSTEDAWW amma� mo '+�m�s�ra.wer�s�.a�am .an.°timm ND�fEALiREAt�lti Axeeaa�Totr��tT � ��li ��� t,�(%�°� �Taer�s� — 13YES mmo DAA L. REGfSTEim LAND SURVEYOR #4843 OYES ®NA STATE OF FLORIDA L6# 000SBT4 _____ NOTE NOT VALID UlaM- eutcm` 4 we 4 4 I - I i