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FW-14-2403Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-222691 Permit Number: FW -10-14-2403 Scheduled Inspection Date: March 11, 2015 Permit Type: Fence/Wall Inspector: Rodriguez, Jorge Inspection Type• Final Owner: DALEY, EUGENE Work Classification: Wood Fence Job Address: 467 NE 100 Street Miami Shores, FL 33138-2446 Project: <NONE> Contractor: SAMADA FENCE INC comments Phone Number Parcel Number 1132060170530 WOOD FENCE 5' HIGH 3GATES CHAIN LINK FENCE 5' ""' "`" ' --- HIGH HIGH GREEN INSPECTOR COMMENTS False Phone: (305)720-6344 March 10, 2015 For Inspections please call: (305)762-4949 Page 2 of 29 Inspector Comments Passed 129 Failed Correction Needed ❑ Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. March 10, 2015 For Inspections please call: (305)762-4949 Page 2 of 29 PERMIT APPLICATION Miami Shores Village 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 UILDING ❑ ELECTRIC ❑ ROOFING F1 ym` 1 OCT 31.2014 BAr FBC 20 la Master Permit No. -- �Lr Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP A CONTRACTOR DRAWINGS JOB ADDRESS: r `� ` O ® 5 1 City: Miami Shores t 1 p� FCounty: Miami Dade Zip: 33 / / 3 8 Folio/Parcel#: It 3 )- 0 � © 1 CJ J 3 0 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): CV e --P__ v 04 V ` Phone#J 0 _T" 4 Ste+ - P1119 Address: 6 Al 67 `©d S l�-�(.l City: C+�.w�.. (% %.t a J State: or -C Zip: �3 6 Tenant/Lessee Name: Email CONTRACTOR: Company Name: �C-N' * L' CIL 4c e_� Ge— Tom- Phone#: J si' S-9-13 "T'2rs Address: �L �A �� t City: CSC Q State: F -C Zip: 3 `� Qualifier Name: C r C i O Phone# `OS /� �d (P3 If L/ State Certification or Registration #: Certificate of Competency #: 1( ��1� 0 (o.? DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: Type of Work: ❑ Addition City: State: Zip: uare/Linear Footage of Work: / ti . ❑ Alteration ❑ New of Work: ❑ Repair/Replace ❑ Demolition 3 GS Specify color of color thru tile: Submittal Fee $ Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Technology Fee $ Training/Education Fee $ Structural Reviews $ _ (RevisedOZ/24/2014) Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $� 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 Signature OWNER or AGENT The foregoing instrument was acknowledged before me this day of�f A- -1W b44 20 e y by V e,N1 y V who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUB Sign:_ Print: Signature Jt'---- 'P F / CONT The foregoing instrum►' 4nt was acknowledged before me this day of �A Q17&p 6.4--. 20 / Y , by e r ti (�` Ca v4- d � J mho is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign:_ Print: Seal:=+ = COMMISStbN rFi3o164 Seal:""''' IYGIy AvIIQ =,c �c CQI�IINlS i i �1318164 =` = EXPIRES: July 17, 21)18 EVIRM July 17 2018 www AARouNoTARY.com '•,` °°•� APPROVED BY , Plans Examiner d3l /A/7oning Structural Review (Revised02/24/2014) Clerk 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. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be personally liable for the worker compensation injuries 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. Owner Print Name: w4 FSE L. Signature: State of Florida ) County of Miami -Dade ) Sworn IR and subsc:nbgd before me this 2 day of e-. 7 Z"- , 20�. By e- e /�-`j of Contractor /I Print Name: z t s Signatur . 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