FW-15-197Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-227318 Permit Number: FW -1-15-197
Scheduled Inspection Date: February 25, 2015
Inspector: Rodriguez, Jorge
Owner: CAMEAU, RASHA AND PAUL
Job Address: 266 NW 92 Street
Miami Shores, FL
Project: <NONE>
Permit Type: Fence/Wall
Inspection Type: Final
Work Classification: Wood Fence
Phone Number
Parcel Number 1131010331270
Contractor: HENRY'S FENCE INC Phone: (305) 669-0180
Building Department Comments
5' HIGH WOOD FENCE AND GATES.
BOARD ON BOARD
INSPECTOR COMMENTS False
February 24, 2015 For Inspections please call: (305)762-4949 Page 11 of 36
Inspector Comments
Passed T9
Failed
Correction
Needed ❑
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid
February 24, 2015 For Inspections please call: (305)762-4949 Page 11 of 36
BUILDING
Miami Shores Village 2615
Building Department
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
Master Permit No. 1 S
PERMIT APPLICATION
&BUILDING ❑ ELECTRIC ❑ ROOFING
Sub Permit No.
❑ REVISION [:] EXTENSION [-]RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF
JOB ADDRESS:
❑ CANCELLATION [:]SHOP
DRAWINGS
— �.-JI V U s the Building Historically Designated: Yes NOv�
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
VMER: Name (Fee Simple Titleholder): & Phone#:) 305 " IIS -2411z.
Addresys�
City: U C g State- .Zip- 331 S
Tenant/Lessee Name: Phone#: --
CONTRACTOR: Company Name:
Address:
City: -r!d1
Qualifier Name:
State Certification or
I
#: Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit: $C2� Square/Linear Footage of Work: CQn0 4J
Type of Work: ❑ Addition ❑ Alteration ❑ New Repair/Replace ❑ Demolition
ggcription of Work: F'1, yah - I—
D
�J _miA
Specify color of color thru tile:,
Submittal Fee
Scanning Fee $
Permit Fee $� CCF $ CO/CC $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(ReviSedoz/24/2014)
DBPR $
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ 1)�
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 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued in the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Sign_ re
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of i � Qf)L4t.1�►�� 2015 , by
!rl ea mo (,A, ✓lwho is personally known to
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
as
Signatur
400,
CONTRACTOR
Th for going instrument was acknowledged before me this
day of 20 by
q
i erso 0
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
Sa • a
ign: Sign:.
Print 1 Print
Seal: Seal:
'4qN. ELI$J1BM PON
-w W COMMISSION t EE 143134
EXPIRES: March 2, 2016
i
APPROVED BY ` Plans Examiner
Structural Review
(Revised02/24/2014)
%- �•.•••••••• v
,
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� $CC 107
;gay �dedlic u
Zoning
Clerk
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Jan 28 15 01:31p 3054429839 p.1
Illbw•✓' /J CERTIFICATE OF LIABILITY INSURANCE
`
DATE(MMlDP11fYYY)
01/28/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: K the certificate holder is an ADDITIONAL INSURED, the policypes) 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
oertlficate holder In lieu of such endolsemengs).
PRODUCER
NAMECT
I PHONE (305)442-2791 AfC: (305)142-9839
Royal Tax Insurance Agency
3195 SW 24 StL
royaltwdnsuranoe3Qhotmall.com
INSURE S AFFORDING COVERAGE NAIC0
Miami, FL 33145
Phone (305)442-2791 Fax (305)442-9839
INSURERA: GRANADA INS CO
INSURED
INSURERS • i
INSURERC:
HENRY'S FENCE INC
INSURER D.
3931 SW 53 Ave
INSURER E :
MIAMI FL 33155 -
INSURER F
Vv V CR/lvG.7 ur-K 111'IUA I C NUMtitKL REVISION MUMMER.
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,
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCEDBY PAID CLAIMS.
�NgEEXCLUSIONS
LTR
TYPE OF INSURANCE
DLSI
UBR
POLICY NUMBER
1411YIlO
MER
POLIC
LIMITS
A
GENERAL LIABILITY
❑ COMMERCULL GENERAL 11ABILITY
❑ ❑ CLAIMS -MADE ❑ OCCUR
(
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0185FL00005114
12/i5l2014
12/15/2015
EACH OCCURRENCE 300 000.00
DAMA-PREMISES E� � $ 100,000.00
MED EXP one tson $ 5,000.00
PERSONAL a ADVIWURY $ 300,000.00
C
GENERAL. AGGREGATE I $ 300,000.00
GEN•L AGGREGATE LIMIT APPLIES PER:
❑ POLICY ❑ PRD- ❑ LOC
PRODUCTS - COMPIOP AGG $ 0.00
$
AUTOMOBILE LIABILITY
ANY AUTO
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A J OS ❑ SOSOWNED EDUI
NON-CUMHIRED AUTOS ❑ AUTOS ED
C
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.oc COMBINED gfSINGLE OMIT !
S
BODILY INJURY (Per person) i $
BODILY INJURY (Per acelderr0' $
P E j $
$
i ❑ UMBRELLA UAB ❑ OCCUR
❑ EXCESS LIAR CLAIMS -MADE
tI
4
EACH OCCURRENCE $
AGGREGATE is
DED ❑ R
Is
t . WORKERS COMPENSATIONY YIN
AND EMPLOYERS' LIABILITYCER98
i ANY PROPRIETOR/PARTNEWEXECU
OFFICERJMEMBER EXCLUOEIYt
(Mandatory In NH)
B yes, describe under
DESCRIPTION OF OPERATIONS below
N i A
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❑ E ❑ OTH-
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E.L. DISEASE - EA EMPLOYFA
E.L. DISEASE - POLICY LIMIT 1 $
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is requiredl
FENCE ERECTION
- -- - - -- --- • • — • •—'�—�• � UAIV GCLLA I E1.71Y
Miami Shores Village
10050 NE 2nd AVE
Miami Shores FL331598
ACORD 25 (2014101) QF
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
f"8-2014 ACORD_C.WPORATION. All rights reserved.
ACORD name andJ&fgo are registered marks of ACORD
■FFECTIVEE DATE: 2WM4
PERSOM VILLOCH
FEM esDaml
MA MESS NAME AND Ate:
HENRY'S FENCE INC
3931 SW 63RD AVE
• •�rx�r10i IT -J,
Vii T. I„ i.
EXPE;ATION DATE; 26=16
HENRY p
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. 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 and has acknowledge that he or she will not use
day labor, part-time employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will
be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of
workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors..
Therefore, you may be 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.
O er
C tractor
Signature
a /
_
Signature:
00-1
State of Florida
of Florida
County of
The forego
'ami -Dade
was acknowledge e me thift
County of Miami -Dade
The fore o g was acknowledge this
da
, 20 \a4.. ,f 1 J
day o
By
By
M
who is p
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who is personal
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Notary:
#EE 185969 ; a'z`
Notary:
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SEAL:
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SEAL:
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HENRY'S FENCE, INC.
3931 SW 63`d Ave.
Miami, FL 33155
Phone: (305) 669-0180
Fax: (305) 669-5992
Email: henrysco a)bellsouth.net
January 27, 2015
Miami Shores Village
10050 NE 2nd Ave
Miami, FL 33138
RE: Fence for 266 NE 92nd Street
Miami Shores, FL 33159
To whom it may concern,
I, Henry P. Villoch, qualifier for Henry's Fence, Inc will be the only person
working on the fence project / installation at 266 NE 92nd Street Miami Shores,
FL 33159.
Thank You,
} m,# y P. Vato•cly
Contractor
Signature:
State of Florida
County of Miami -Dade
Thefor mg was acknowledged before me thi�
day of015
who is na11y know me or has produced
�`�111111111111//���
as identificationp\C�Q�jS R09A1
V .•''M\SS10&F •.• C , i
NO
SEAL:
a 2'; #EE 185%9 ; c
o Shadow Box
o Vertical Picket
o Board on Board
May 2009
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 2'deep
ALL wood must be pressure treated
All fasteners must be corrosion resistant
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
woad members
with two corrosion
resistant fasteners
per connection
F SAP
Id`s
Ax
124.69' CM
n� 4' GLF.-7 \
—2533' � •
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24.66' (C&M)
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1{ .roya
Miami Shorts Village � �'• �'
D TE
ED BY
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T ,
l(sJLCT TO COMPLIANCE WITH ALL FEDERAL
® SNR Cni,JNTY RHI FS AND RFC;UI ATIONS
ABBREVtAT10NS:
SVW=SIDEVVV-K, CBS=CONCRETE BLOCK STRUCTURE, CLF -CHAIN LINK FENCE, PL -PROPERTY UNE,'DUE=DRAINAGE UTIUTYEASEM ENT, IP -IRON PIPE.
F=FOUNb, AIC -AIR CONDITIONER PAD, P/C=PROPERTY CORNER D/H=DRILLED HOLE, V19FOADODEN FENCE, RES -RESIDENCE, CL -CLEAR RB--REBAR,
LIE—UTILITY EASEMENT. CONC=CONCRETE SLAB. RNV -RIGHT OF VAY, DE=DRAINAGE EASEMENT, CIL=CENTER LINE, O=DIAM7ER, TYP=TYPICAI
' M=MEASURED. R=RECORDED, ENCR=ENCROACHMENT COMP=COMPUTER, ASH -ASPHALT. N/D=NAIL & DISC. S=SET, FEE -FINISH FLOOR ELEVATION,
O/S-OFFSET. P/P--POWER POLE, OHP -OVERHEAD POV ERLINE, NM=VATERMETER
MMAAWNREY"VA = ELEVATION BASED ON LOC. #
NOT VAUO UNLESS EMBOSSED WITH CONCRETE= z•.: •s•.: •::: :•.:..:••� •.:•.z •...� -
MAINTENANCE& DRAINAGE EASEMENT= M &D.E. CBM# ETV. TYPE OF SURVEY: BOUNDARY SURVEY
SURVEYOR'S SEAL SURVEYOR'S NOTES: 1) OWNERSHIP SUBJECT TO OPINION OF TITLE. 2) NOT VALID WITHOUT THE SIGNATURE
AND RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER 3) THE SURVEY DEPICTED HERE IS NOT
.6�. COVERED BY PROFESSIONAL LIABILITY INSURANCE 4) LEGAL DESCRIPTION PROVIDED BY CLIENT. 5)
hE UNDERGROUND ENCROACHMENTS NOT LOCATED. 6) ELEVATIONS ARE BASED ON NATIONAL GEODETIC
VERTICAL DATUM OF 1929.. 7) OWNERSHIP OF FENCES ARE UNKNOWN. 8) THERE MAY BE ADDITIONAL
RESTRICTIONS NOT SHOWN ON THIS SURVEY THAT MAYBE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY. 9)
CONTACT THE APPROPRIATE AUTHORITY PRIOR TO ANY DESIGN WORK FOR BUILDING AND ZONING
INFORMATION. TO) EXAMINATION OF THE ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED
REVISED: INSTRUMENTS, IF ANY, AFFECTING THIS PROPERTY.
Additions or deletions to survey maps or reports by other than the signing party or parties is piohibited
without written consent of the signing party or parties.
BEARINGS WHEN SHOWN ARE REFERRED TO AN ASSUMED VALUEOF SAID P8 . 10 PAGE 39
N
0
LOCATION SKETCH
SCALE: NTS
N.W. 3rd AVENUE
LOT 13 LOT 12 Z
LOT 14 LOT 11
LOT 15 LOT 10 '
LOT 18. LOT 9
LOT 17 0.
LOT 18 LOT 7 co
LOT 19 LOT 6 1 m
LOT 20 LOT 5
Fences Good Side pit
suPporting rnernhefS the vertical and horizontal
interior of the of a fence Shall f
and the plot °n which the fence i ace the
finished side shaft f s located
lot or any abottin
g rigtit=®f-wayce the adjoining
CERTIFIED TO: RASHA C. SORAY
PROPERTY ADDRESS.: 266 N.W. 92 ST., MIAMI SHORES, FL. 33160.
LEGAL DESCRIPTION: LOT 9 AND WEST 1/2 OF LOT 8 BLOCK 146
OF MIAMI SUORES SECTION 6 SUBDIVISION
ACCORDING TO THE PLAT THEREOF AS RECORDED IN PLAT BOOK 10 AT PAGE
OF THE PUBLIC RECORDS MIAMI—DADE COUNTY, FLORIDA
I HEREBY CERTIFY That the survey represented
thereon meets the minimum technical requirements
adopted by the STATE OF FLORIDA Board of.Land
Surveyors pursuant to Section 472.027 Florida
Statutes.
There are no encroachments, overlaps, easements
appearing on the plat orvisible easements other than
as shown hereon.
ADIS N. NUNEZ
REGISTERED LAND SURVEYOR
STATE OF FLORIDA #5924
39
SINCE 1987
BLANGO SURVEYORS ING.
Engineers • Land Surveyors • Planners • LB # 0007059
555 NORTH SHORE DRIVE
MIAMI BEACH, FL 33141
(305) 865-1200 Email: blancosurveyorsinegyahoo.com Fax: (305) 865-7810
WE: g
0302
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120652
14-142