FW-14-2574Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-225462
Scheduled Inspection Date: December 18, 2014
Inspector: Rodriguez, Jorge
Owner: ACOSTA, ESTHER
Job Address: 177 NW 96 Street
Miami Shores, FL
Project: <NONE>
Contractor: ULTRA FENCE INC
Liunaing uepanment comments
Permit Number: FW -11-14-2574
Permit Type: Fence/Wall
Inspection Type: Final
Work Classification: Wood Fence
Phone Number
Parcel Number
1131010250140
Phone: (305)592-4578
WOOD FENCE BOARD ON BOARD WITH A WOOD Infractio Passed Comments
DOUBLE GATE ALL 5' HIGH. I
INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-223802. no access, gates lock,
no answer to the front door.
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
December 17, 2014 For Inspections please call: (305)762-4949 Page 25 of 29
Miami 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
FBC 20
Permit Type: BUILDING
Permit No. f - I ` 3 ;)`
Master Permit No.
OWNER: Name (Fee Simple Titleholder): C—s- - le -r A c L 4a Phone#6 %(0)
Address: 1 °1 q 1",I (A-) 9 (,C l
City: W I G ry-V 1 Z4i cjre State:
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: 19'1 t') L -"j
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 1 t ) i 10 26 0) 4 D
Is the Building Historically Designated: Yes
Compan
4 � 9'U
City:
Qualifier Name:
State Certification or Registration #:
Contact Phone#:
NO Flood Zone:
�— L Zip:
� - a
DESIGNER Architect/Engineer. Phone#:
Value of Work for this Permit: $ 5�)— 160 . b<> Square/Linear Footage of Work:
Type of Work: ❑Addressee�- ❑Alterattion ❑New
Uo
Description of Work:
(�, O®6 OCX)o0 >_ oorAep11
COLOR THRO UGH ROOF TILE IS REQ UIREO acknowledged I
Submittal Fee $ 96 `• On Permit Fee $ If—f)® CCF $ CO/CC $
Scanning Fee $
Notary $
Radon Fee $
Training/Education Fee $
DBPR $ Bond $
Technology Fee $
❑Demolition
Doable Fee $ Structural Review $
TOTAL FEE NOW DUE $ �� v
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
EM PROVEMENTS 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged /l
Signature 1� Sign
Owner or Agent 7 Contractor
The foregoing instrument as acknowledged before me this 1yD. The foregoing instrument was acknowledged before me this
day of day of 20 � by
who is rally known to me r who has produced who is rally known me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign: °, " -
Print: no�
My Commission --
,�.�
_ ��„ �-; Notary Public -State of Florida
* • My Comm. Expires Jul 7, 2015
APPROVED BY
--'k Plans Examiner
Structural Review
(Revised 07/10107)(Revised 06110/2009)(Revised 3/15/09)(rev6/4/10)
NOTARY PUBLIC:
We
A
My Commissi ` , . 1�. -
,.SPnr d� ANA M. TORRES
Notary Public - State of Florida
My Comm. Expires Jul 7, 2015
Bondey Through N;tional Notary Assn.
Clerk
4 '
� n
Construction Trades Qualifying
Board
:BUSINESS CERTIFICATE OF COMPETENCY
14, 1 OBS00420
ULTRA FENCE INC
T RES LA
ZARO
Is certified under the PrOftons of Chapter 10 of Miami -Dade County
TIi130 1P
TINi�T
ft
,:
I9IN1&$ NAMBAXXATION REcEIPT NC
.TWNcr= tnicRENEWAL SEPTEM
41 NW 64 ST
ANAL =1 2943954 Mustbedi-m—
i
EXPIRES
BER 30, 2015
3316E ed atptece of busbress
m� Pursuant tot ountV Code
Chapter BA — Art. 8 & 10
OWNER SEC. TYPE OF BUSINESS
ULTRA FENCE INC 196 SPECIALTY BUILDINGBY TAX PAYMENTCO CTOR
CONTRACTOR 82.50 10110/2014
Worker(s) 1 1OBS00420 CREDITCARD-15.001208
This botaillidnewTax Receipt only coufftms payment el the Local BudnessTax.The Beceipt is ®ata license,
permit, ara car0cadon oltb*bolders gr aliGcetions,te do basiaess. molder mast comply widi say sovemmental
Of neogovenmentai ragatat lows and regairemeadswbich apply to the business.
TheRECEIPT N0. above, mot be displayed on all commercial vehicles -f liami-Dade Code See ea M.
M larmorehdonution,vm m Aiamidadegovitaxcoiiector
Nov 2014 03:24p WILVER ALMARALES 305-382-6777 p.1
! DATE tl/M1IIDDJWI
CERTIFICATE OF LIABILITY INSURANCE _ �
I...—. ------- -----• -----._--..—.._—..—_._— L--- 120/14
i PRODUCER WAM Insurance Agency THIS CERYIFICATE IS ISSUED AS A (NATTER OF INFORMATION
RI
10837 SW 88th St. Ste 7-1 O„NLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Miami, FL 33178 HOLDER -'THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
A TER THE CQl/ERAqE A WORQMIF±j .I�?1,ICJEg
Pham (305)274-4353 Fax (305)2749994 INSURERS AFFORDING COVERAGE ^— — MAIC
_._..
I�RED ULTRA FENCE INC. iNstJ> A: GRANADA INSURANCE COMPANY
7941 NW 64 STREET INSURER B:
Miami, FL 33166 INSURERC;-
INSURER D:
INSURER E:
COVERAGES -
--.. _... --- •.._—.... — .-- ----.. ---• • - - --INSURER F:
THE POLICIES OF INSURANCE LISTED HAVE BEEN ISSUED TO THE INSURED NANEDABOVE FOR THE POLICY PERIOD INDICATED. NO W Wg ANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
INSR ADM
MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICES- AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAM.
Tp �p$q — TYPE OF NSURANCE — POLICY NU>118ER � � POUGV ExRRAT[ON`
— .. _— . --- •• —• GATE DATELIMITS
GENERAL LIABILITY — EACH OCCURRENCE
V COMMERCIAL GENERAL LIABILITY 0185FL00052545 09/Q6M4 09/06/15 b —
PRp49SE$(Eaocauenoe) __-' 100,OW
�..: -� CLAIMS MADE OCCUR ` MED EXP (Any one person) --
A I L -i f PERSONAL&ADV INJURY 1'OQ(},066
Ll
GE
__ — GENERAL AGGREGATE 2'ODO,ODO
N L AGGREGATE OMIT APPLIES P PRODUCTS - COMROP AGG 2'OOOdOQ
W POLICY I PROJECT LI LOC — -- -- - -
AUTOM081LELIABBJTY ..—..------ --•-- •-- -•--� '-• - __ .._
u ANY AUTOWA �Cpwq
'�� SINGLE LIMIT
C7 ALL OWNED AUTOS
I.� SCHEDULED AUTOS 13ODLY INJURY
HIRED AUTOS en
LJ NON OWNED AUTOS BODILY INJURY
. (Per erxiderd)
PROPERTY DAMAGE
GARAGE IL
� �AUTO ONLY - EA ACCIDENT
�. Li Li ANY AUTO OTHER THAN EA ACC --
_-- • - —_-- .. ' AUTO ONLY: AGG
4
EXCESSAIYBRELLA LIABILITY EACH OCCURRENCE OCCUR CLAIMS MADE AGGREGATE -- - - - --
J DEDUCTIBLE ----......—. _ _...
RETOMON a
-- WOMERS Cd�APENSA*d_AND . _ ..... -- - - - I — — - ... - _ . . _. . , . .. _ ..— — i :.." • --- --
EdIPLOYERS' LIABILITY - �_-� 1N�YSTJ Al.
B ' ANY PROPRIETOR/ PARER/ EXECUTIVE E.L. EACH ACCIDENT-
I OFFICER / MEMBER E7tCl UOEDT -- _ ---- — • _ _ ___-- If 1Ns. descft under EL DISEASE - EA EMPLOYEE
_APRqIAL
OTHERPROVIgtONS.Getaw .. ------ - E.L D15EASE - POLICY L>wI1Tf i
aesCIi1PTIOIY of oPERAT1pNS! LOCAT1oN31 VEHICLES r EXCLUSIONS ADDED BY ENDORSEWNT / SPECIAL PROVISIONS
FENCE INSTALLATION - LIC #11 OBS00420
CERTIFICATE HOLDER- - -- - -- - -- -- - - - - -
_-- -- __---- -• -- CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE IBStMG INSURER WILL ENDEAVOR TO MNL
CITY OF MIAMI SHORES 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NIWED TO
THE LEPT, BUT PAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIASUM
10050 NE 2 AVE OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES.
MIAMI SHORES, FL 33138
RUTH I RILED REPRESENTATIVE -- ---- _--_
305-756-8872 : WILVER ALMARALES 1
ACORD25(2001MS) OF -- .....__...__. _._._.. __ ..._....__.
C�}ACO!RD COf8S+01iAT10N 1988--
NOTICE OF (ELECTION TO DE EXEMPT
If this application contains incomplete or inaccurate information, it may cause a delay in the issuance of your exemption. An
officer electing an exemption under Chapter 440, Florida Statutes, is not entitled to benefits under this chapter.
section 1:
APPLICANT INFORMATION
First & Last Name:
State Driver's License Number.
Date of Birth:
lazaro torres
State ID Number. State: FL
1/5/1956
Social Security Number (last four digits): 8704
Email Address: lazarofence@belisouth.net
section z:
CONSTRUCTION INDUSTRY APPLICANT ($50 FEE REQUIRED)
of a Corporation (Construction)
ate Title: PRESIDENT
section s:
This section should be completed with information specific to your corporation or to the limited liability company in which you are
a member. The name of the corporation or limited liability company listed on this application MUST match the name of the
corporation or limited liability company as registered with the Florida Division of Corporations.
Name of Corporation or LLC: ultra fence inc
IF YOU NEED TO APPLY FOR A FEIN, CLICK HERE
Business Name (DBA):
Applicant's Address of Record: 7941 nw 64 st
City Miami
State: FL Zip 33166
FEIN: 41-2215274
Phone: (305)592-4578
County. Miami -Dade
Click on the arrow(s) next to the text box(s) to view a list of available Scope classifications/trades; for the form type chosen in
Section 2. Click on the appropriate scope to select If you are unsure as to which classification/trade to choose, please contact
your workers' compensation insurance carrier. If you do not have a workers' compensation insurance policy, contact the
National Council on Compensation Insurance (NCCI) at 1-800-622-4123 option 5 to obtain a classification code.
06400 Fence Scope 2: Scope 3: Scope 4:
Installation and
Repair -Metal, vinyl,
Wood or Prefabricated
Concrete Panel Fence
Installed By Hand
aeutlon 4:
The corporation of which you are an officer or limited liability company of which you are a member must be registered and in ACTIVE status
with the Florida Division of Corporations. Applicants applying as an officer of a corporation must be listed as an officer of the Corporation with
the Florida Division of Corporations. List the document number on file with the Florida Division of Corporations.
P06000108154
a:
Pursuant to Chapter 489, F.S. (contractor licensing law), list certified or registered licenses related to the scope of business or
trade listed In Section 3 held by the applicant, or the certified or registered license numbers held by the qualifier for the
corporation or limited fiability company listed on this application. The business name listed on the license MUST match the name
of the corporation or limited liability company as registered with the Florida Division of Corporations and on this Notice of Election
to be Exempt
10bs00420
Section 8:
If you have submitted an electronic payment for this application, the transaction confinTmoon number is listed in the following space:
Confirmation Number. 122575547 Application Number. E00033688
Section 7: Yes
Are you affiliated with any corporation or limited liability company other than the corporation or limited liability company to which
this application applies?
Name: lazarofence inc FEIN 8005M7 Name: FEIN
Name: FEIN
Section 8: CONSTRUCTION INDUSTRY AND NON -CONSTRUCTION INDUSTRY LLC MEMBERS ONLY
To be eligible for a construction industry exemption or a non -construction limited liability company exemption, an applicant must
have the required ownership of the corporation or limited liability company.
I am a shareholder owning at least ten percent(10%a) of stock of the corporation listed on this application.
Section 9:
I certify that any employees of the corporation or members of the limited liability company listed in Section 3 are covered by
workers' compensation insurance. Please identify the workers' compensation insurance carrier that covers any non-exempt
employees.
Carrier Name: nova casualty company
Section 10: FRAUD NOTICE
A. Any person who, knowingly and with intent to injure, defraud, or deceive the department or any employer or employee,
insurance company or any other person, files a Notice of Election to be Exempt containing any false or misleading
information is guilty of a felony of the third degree.
B. Attestation of applicant — By providing my name below, I attest that i have read, understand and acknowledge the
foregoing notice.
C. Acknowledge that this Notice of Election to be Exempt does not exceed limits for corporate officers, including any
affiliated corporations as provided in Section 440.02, Florida Statutes.
First Name: lazaro Last Name: torres
Note: The Division has 30 days to review your application to determine if it meets the eligibility requirements for the issuance of
an exemption. The Division will either issue a Certificate of Election to be Exempt or notify you that your application is incomplete.
The Division reviews and processes exemption applications in the order they are received.
Exemption information is reflected on the Proof of Coverage database the day following the Issuance of the exemption. Visit the
Division's website at httpJ/www.myfloridacfb.comANc to print your certificate.
Miami Shores Village
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 -
f:
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�y be
personally liable for the worker compensation injuries of M 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.
Owner
Print Name: r Print NE
&C
Signature:!e, Signatw
State of Florida )
County of Miami -Dade )
Sworn to and subscribed before meP
Y or 20
B
(SEAL) ANA M. TORRES
State
County of Miami -Dade )
Sworn to d subscribed
day of
Contractor
By
before m
120 1
ANA M. TORRES
-� o 'o: vuiaiy ruuuc - aLme or rlorloa
dtd&y Public - State of Florida T cre
y Comm, Expires Jul 1, 2015 " Commission # EE 110471
Commission # EE 110471 °,``,�°`O�
Bonded Through National Notary Assn. Bonded Through National Notary Assn.
STATE OF (FLORIDA)
COUNTY OF (DADE)
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
SURVEY AFFIDAVIT
The undersigned Affiant, F-43 Y' C A COS . does hereby attest that
(Property owner)
The attached survey, performed by L -'-,r .e5 4- (;a1f4 L
1 � (,�(Name of surveyor's company)
For address: 1 \� �° W
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.
Further, Affiant say eth naught.
t
Pro rty Own gna r Si to
e-4 h,PK _res
pe a re Property Owner Print Name
SWORN TO AND SUB ore me this 10 ay of
Affiant is ersonally kno me, _produced as identification.
Revised on 5P12/2009! Revised on fin M9
Notary
,,o,oY'n'•°�.,�
RES
AN: -State
Notary Puof Florida.;
7, 2015CommiE
c
My CommJul
110471
Bonded Throl Notary Assn.
r X.
o Shadow Box
o Vertical Picket
Board on Board e
Miami Shores Village
{ Building Department
111 m
�;. 10050 N.E.2nd Avenue
' Miami Shores, Florida 33138
kip Tel: (305) 795.2204
Fax: (305) 756.8972
j e
WOOD FENCE DETAIL
Fences <= 5' high posts spaced at Ton center maximum
Fences <= 4' high posts spaced at 6' on center maximum
Fence must not exceed 5' in height
Miami Shores Village
APPROVED
BY
. DATE
ZONING DEPT
87
! Y11 fill
1
BLDG DEPT
ili11-1.-1
SUBJECT TO COMPLIANCE WITH ALL FEDERAL.
STATE AND COUNTY RULES AND REGULATIONS
1x pickets fastened
with two -corrosion
resistant fasteners per
connection
.2x4 horizontal
pressure treated
wood members
with two corrosion
resistant fasteners
per connection
Lj Ll Ll 1� I I IF
.060.0
0000..
•
..
0000..
6.....
0000..
•
0000..
.....�
4x4P ressure treated
. 6 • •
..
posts embedded Tin
' ....6
6 • •
":6 6
6
concrete footing 10"
.. • •
; 6..: •
666.6
j diameterx2'deep
•• ••
6 , 6
•
0000..
•
0000..
ALL wood must be pressure treated
:0000.
All fasteners must be corrosion resistant
' '
••••
'
No less than two fasteners in any connection
May 2009
F-752 3 ¢
REQUOtEMENTS:
-`1/ SYo Access gaY s merst open outward
away from -the pool area.
Cif iOr/ M.4� be self-closing/self-locking,
a located on pool side of the gate
and located no less than 54"
from bott9m of gats.
FOC 424.2.17.1.3
This property described as:
Lot 14, Block 3
PLAT OF RESUBDIVISION OF
BLOCK 3
BONMAR . PARR,
POOL A9QUjA[8IUIEN -rqj
according to the Plat
SELF-CLOSING/ SELF-LOCKING
thereof, - as recorded in
GATES REQUIRED
Plat Book 42, . Page 60
FENCE: 4' HIGH (MIN.)
AND
of the Public Records of
NON -CLIMBABLE
IF NEIGHBORS
Mame—Dam Cvunty�:.Flc�tia.
REMOVE FENCE/
WALL, OWNER
MUST REPLACE
WITH A 4' FENCE ON
OWNER'S PROPERTY
.OPERTY OF: Acosta, Esther., 177 N.W.. 96th
Street, Miami Shores, •flofida:.33150
....:.
A BOUNDAT
• • •
• •
t'AIJD#'ifl10 Tr111L1N1 NATURE
111id►ti1K:iAA1.UAZ dxt:yl.of
SURVEY
f hereby terrify that the wrvey repro-
• • • •
I.ANNES AND GARCIAM"f;..• i ••••
••0•••
rtIDA tJ(7 1F0 SNlti i1 t1
autrR . -
rented hereon meets the minimum
techoinl standards set forth b the Board
1-11. 9 209!t • • • • • • • •
• • • • • • •
00000
000000
of Land Surveyors' in. chapter 61G17-6
SIllt%'F %'ORS-NIAI'PF RS-I.ANI)W1 .&N. Itti••
Florida Administrative Code pursuant to
Section 472027. Fla. Statutes. There are no
ERNESTO E . ESPINOS�i •`�9 4 6 • •
• •
666606
encroachments. overlaps, easements
•
' FRANCISCO F. FA.TARDQ //;767• .' �•••••
�.•.•:
appearin n the Plat, other than as
•
Office address: 359 Alcacar Avenue.( oral Ga1Il6s llusida 33134• • • •
• •
shown roto. /
13U$16W79W (954)5223-8663 0000
—
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