FW-16-1198 CL
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores,FL
Phone: (305)795.2204 Fax:(305)756-8972
Inspection Number: INSP-258091 Permit Number: FW-5-16-1198
Scheduled Inspection Date:May 18,2016 Permit Type: Fence/Wall
Inspector:Mesa,Michael Inspection Type: Final
Owner. RESTANI,MERCEDES Work Classification: Iron/Ornamental
Job Address*102 NW 97 Street
Miami Shores,FL 33150- Phone Number (306)T85-6195
Parcel Number 1131010250080
Project: <NONE>
Contractor: ULTRA FENCE INC Phone:(305)592-4578
Building Department Comments
ALUMINUM Infractio Passed Comments FENCE 5 FT HIGH WITH DOUBLE GATE 5' INSPECTOR COMMENTS False
HIGH AND ONE ALUMINUM SINGLE GATE
INSTALLATION 4'HIGH
TO CLOSE PERMIT#FW14-1290
Inspector Comments
Passed
Failed
Correction
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-Inspection fee is paid
�2
May 17,2016 For Inspections please call:(306)762-4949 Page 24 of 44
Miami Shores Village RECEIVED
Building Department k . A s
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BN
Tel:(305)795.2204 Fag:(305)756.8972
INSPECTION'S PHONE NUMBER(305)762.4949
BUILDING Permit No._
PERMIT APPLICATION Master Permit I- �
- v
FBC 20
Permit Type:BUILDING
OWNER:Name(Fee Simple Titleholder):
Address•
City:
State• L P.
Ten=Wl,essee Name: Phone#•
Email:
r d
JOBADDRESS: IIT 2. i�A�
• ,ami Dam S
City: Miami Shores ��Y:
Folio/Parcel#: N 1 2,0` 02�5: ry-)�?-o
h the Building Historically Designated:Yes NO Flood Zone:
CONTRACTOR Company Name:
Phone#;
Address:
City: 1(Y\��ll/1 Jl• State• Zip: .5
5S 2
QualifierName: Phone#
State Certification or Registration#• Q Certificate of Competency#•
Contact Phone#• Email Address: �lnI�O
DESIGNER Architect/Engineer: Phone#:
Value of Work for this Permit:$ • Gd Sgnare/LSnear Footage of Work:
Type of Work: OAddress OAlteration ONew ORepair/Replace DDemolition
Description of Work:
-IX
R&.2 &
COLOR THROUGH ROOF TILE IS REQUIRED acknowledged bps
**,�a,�a«**a,�*****s*asaa*rssr,w+e**s**er,�*sr,r,�F�g,sa*,t,w*a,�*ert*art,►r*at,r,ta*s,t��a�**,a*ar*,ar�,r*rr,�
Submittal Fee$ HCl • A Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Training/Education Fee$ Technology Fee$
Double Fee$ Structural Review$_.�._ ----------
TOTAL FEE NOW DUE$ Cn
V
Bonding Company's Name(if applicable)
A Bonding Company's Address
City State Zip
i
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
all work will be ed to meet the standards of all laws regulating
the issuance of a 't and that perform
commenced 'or to P�
lm
construction in this jurisdiction. I understand that a she permit must be secured for ELECMCAL 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 negulatmg construction tion 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 COMMNCEMENT."
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 comtmction lien law brochure will be delivered to the person
whose property is Mbject to atnachment 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 vier the bst l�rt'� g permit is Laved In the absence of such posted notice, the
inspection will not be approved and a reimpecAion fee will be charged
*2ML�
Signature Signature
or Agent Contractor
The foregoing instrument was ackrnnwl ore me this The foregoing instrument was acknowledged before me this
20 by ,, day of ,� 20 V.by
o is personal y known me or who uced is personally known to or who has produced
identification and who did take an oath. i tificsrtion and who did take an oath.
NOT Y PUBLIC: NOTARY PUBLIC:
Sign
Print: ANA M TORRES 2
MGM e of Florida , . .. ANA M TORRES
My fig: Commission#FF 210912 M Co a Pow•no of Fla
M Commission Exp` ,, r= My Comm.Expires Jul 7,2019 i ConmMlon#FF 210912
'' .4t�°� ° gNatlonalN ►Assn My Comm.Expirm Jul 7.2 019
r,r�r*s►*+�,r*r**,r*�**�ar,rs,*,ra*+�• *,►,►,r*,�• �,►r,�*+�***r*,r***rr**ss*,a**s,► LSY!!`I�` *� Ikllt�l.
APPROVED BY Plans Exam. Zoning
Structural Review Clerk
(RrAwd 07n0M)aWvised 061102o09)OWised 3115109XreW41101
•
Ultra Fence Inc
7941 NW 64 ST
MIAMI FL33166
CONTRACTOR WORK E.XCFMPT AFFIDAVIT
Sate of Fl
County of Miami-Dade
Before me this day personally appeared Lazaro Torres who,being duty sworn,deposes
and says:
His workers compensation exempt form is attached for reference to pull out
permit. Which expires.l 0/9/2016.
That he will be the only person working on the project located at
Swom to(or affirmed)and subscribed before me this day Of, Com, ,/20 A&
BYt �( j T
Personally Known
ME
Notaryt'Pubt-State of Florida
• COMMI IN#FF 210912
My Conan.Ex Jul 7,2019
1 t l f y:M
Pri e or stamp name of No
s�
Miami shores Village
logo Building Department
` �,s10050 N.E.2nd Avenue
��ORIDp' 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.
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS
CONTENTS.
Signature:
Owner
State of Florida
County of Miami-Dade
The foregoing was acknowledge ;fore me this day of ,20�
By e� ( who' personally known to me r has produced
as identification.
Notary: ly,1111" DANA M TORRES
.��ppV 1'bgh
:�°� ,`�; Notary Public-State of Florida .
SEAL: • '•= Commission#FF 210912
� k My Comm.Expires Jul 7,2019
°'•/ '��, Bonded through National Notary Assn.
IOZ N KJ G7 51.
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97
7th
20 ASPHALT PAVEMENT
LRS AMES
(1)A Oar Int 8=&P.JV a'WW VE RIV THOMAS J. KELLY , INC.
(2)A Lam► SUL MC lip 10 3r AIM DE W ALLEY li</M' L.8 # 6486
(V A QF amupw aW w -Ir At/Er vyo8► PL IMMMS
SW SS 120 STREET PNMFEST. FLORIDA 33156
M) )42
242. 7N2 OADE (954) 779-3288 IRtWD
(78 -8484 DADS FAX (954)779-3260 BRWD FAX
DATE FIELQ W ZIC SCALE SURVEY NO.
4 0 %29/2014 1"=20' 14-0420
LES OF SURVEY imamShoot 1 of 2
•A......MCD rAnicE AIC. 11Mz�' s f> iOC[x1mucam NOW...MATOMAL0E00ETIC VERTiCAI.DATUM %.
C . .CALCULATED cs r � WW :aarraFRBWM0 MATURE FLOOD ZONE: X
CL... cLenR ar... €we i� �a }AIA r tiavt::mom THIS IS A FLOOD
END .EWROACHMW P.D. 8f>JWOFGYRt/ATUW P.oc...aol�nr'a► r ►=. � ` _14AZARD ZONE _
a . r� aD►r r � e . . ✓THIS IS NOT A FLOOD
OJL...OMHADiti w:r.-..:'wAT�it� r�rEte - cx....:cHORiY'muaT =.'t ��.?-;_. .°, M..:eCR '+ HAZARD ZONE
P.B....PIAT ti00K M.....MEASURED D.E.....DItAgNA0E E118EIf�Aiy t3.LP..:.:. �I` I0
:PANEL NO.% 302/1.
P&...PROPERTY UNE CDNC..CONCRETE F.H.....FIRE HYDRANT •.SMEwnLK COMMUNITY 4- 120652
UP...UTOMY POLE F.D....mm R.....RADM UA....UnUTYEASMAW DATE OF FIRM: 09/11/2001
clap....CHAIN UNKFENCE BASE FLOOD: NIA
CERTIFY TO: FINISH FLOOR: NIA
Mercedes Restani LOWEST WA
Columbia Title Of Florida, Inc. C/B/A Ewm Title. ADJ GRADE
Chicago Title Insurance Company
LEGAL DESCRIPTION:
Lot: 8
Block: 3
Subdivision: Resubdivision Of Block 3 Bonmar Park
According to the Plat thereof as recorded in
Plat Book: 42 Page: 60
Public Records of MIAMI-RADE County, Florida.
ADDRESS:
102 NW 97 STREET-
MIAMI
TREETMIAMI SHORES, FLORIDA 33150
Encroachments Noted:
LOCATION SKETCH
SCALE: IIS.
NW 97th Sl
PR
_ i
' 4
3 5 6 7 8 so'
. W
' 15' ALLEY
co
Notes 13 12 11 10 9
A) Ag t7MMM=&or eaafteM mts abase
humor aro of apPm W mtma. Fun awmnaMp
by*W mum. L*jW owmrwl*of teasu cwt
datermeed. — I
0)716y is bttendad for motgage or rafiwnm
wr wwkh for fids we by those to whmt it it '
certified.The amwy Is apt to be and tar coat! am — 1
permitting.dasiga,er ouy other uas without written aw- — — —
0 CWa r=amJ. "'mm.
N W 96th ST.
C) Cede wtretee amd the aaeroh era mr rofearea
m rhe aurrsy.
O) The flow kf r wttoa shoe Mn"don not bapiy
that the refaremad propw"wig or WM cwt be free
from floodeg or dmwga and does mot aroah ow0ty
m the Pwt of tba fwwt,a7 alfioa or anplgyss tiarwf,
for my dmwge that rn dtr frwlll6ePes.a%saW
hdamctim.
4 The tends daph tad harem mm mrrayed par tiw
egos deaa ffm and o cW=as ft ewaaaMp ar -
awttem of title aro mads or hM ed.
F)'Ueda rwW EmuvwWp me.if say,not b=W,
2 iwraby that t!w an-my reprusaW '
iaraao eats neisww ftcbr*d stae-
""` "`Ear of`�Ad.W. THOMAS J. KELLY, INC.
t.17.ti62 Fie Ad.e.uwe Paruwm►
sora
L.B. #6486
SURVEYORS-MAPPERS-LAM PLANNERS
8123 SW 120 5T116ET P ; FLORIDA 33156
1786)242-7692 MIXE 0""9-3M 6RMtp
L s fM7 242-6494 DADE FAX MJq 779-3260 BRWD FAX
r JDATE FIELD WORK SURVEY NO.
03/29/2014 r 14-0420
Miami Shores Village
10050 N.E.2nd Avenue NWS"' `
Miami Shores,FL 33138-0000 k z
Phone: (305)795-2204
Expiration: 1111312016
Project Address Parcel Number Applicant
102 NW 97 Street 1131010250080
MERCEDES RESTANI
Miami Shores, FL 33150- Block: Lot:
Owner Information Address Phone Cell
MERCEDES RESTANI 102 97 Street (305)785-6195
MIAMI SHORES FL 33150-
Contractor(s) Phone Cell Phone Valuation: $ 2,300.00
ULTRA FENCE INC (305)592-4578
Total Sq Feet: 14
Approved: Available Inspections:
Comments:
D : Inspection Type:
Date Approved:
Final
Date Denied: Foundation
Type of Construction:Other Additional Info:ALUMINUM FENCE 5 FT HIGH WITH Review Building
Classification:Residential Scanning:3
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.80 Invoice# FW-5-16-59636
DBPR Fee $2.00 05/102016 Check#:2310 $50.00 $67.80
DCA Fee $2.00
Education Surcharge $0.60 05/172016 Check#:2311 $67.80 $0.00
Permit Fee-Wire&Wood $100.00
Scanning Fee $9.00
Technology Fee $2.40
Total: $117.80
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore,I autho 1P th above- contractor to do the work stated.
May 17,2016
Authorized Signature:Owner / App scant / Contractor / Agent Date
Building Department Copy
May 17,2016 1