FW-12-2441Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 183552 Permit Number: FW -12 -12 -2441
Scheduled Inspection Date: January 28, 2013
Inspector: Bruhn, Norman
Owner: LACHMUND, LEE
Job Address: 151 NE 93 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: SAMADA FENCE INC
Permit Type: Fence/Wall
Inspection Type: Final
Work Classification: Wood Fence
Phone Number
Parcel Number 1132060133040
Phone: (305)720 -6344
Building Department Comments
WOOD FENCE BOARD ON BOARD 5' HIGH AND ONE
GATE
Infractio Passed Comments
INSPECTOR COMMENTS
False
Inspector Comments
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
January 25, 2013
For Inspections please call: (305)762 -4949
Page 14 of 28
4
Miami Shores Village
Building Department
90050 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
JOB ADDRESS: / S / /U E S
FBC20
1-1,0
Permit No. [ 2.7. 2444
Master Permit No.
ROOFING
City: Miami Shores County:
Folio/Parcel #: 11 - 3 0 6 1 3 ! 3 0 X10
Is the Building Historically Designated: Yes
OWNER: Name (Fee Simple Titleholder):
Address: // r 1 F t z S q`
City: t-1; ; S State: Pc Zip:3 ' !3
Miami Dade
Zip: 33 /J
NO Flood Zone:
e-glo /o-I de
Phone#: 3 OS' 9 4 T 6 yid
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: ge"..- 4a-
Address:! /10 w 31 S
City: Gam- Cwt � State:
n
Qualifier Name: > eNt 0
H
c- C/a—
State Certification or Registration #:
Contact Phone#: ? Or 3 ao (o 3 4 .4
DESIGNER: Architect/Engineer:
Phone#: q ry rr J- k 3r$
Zip: 3)(12-
Phone#: 9SY STg �,,/e* 43J`r
Certificatee e4-003%-ti
Competency #: // 4. 0 03'13
Email Address: S�YY°►- ` a- '7'n S /i • . Crs -a-1
Phone#:
Value of Work for this Permit: $ � 4 7 T ®O Square/Linear Footage of Work: c /
Type of Work: ❑Addition :Alteration
Description of Work: ILO (so f Q'v+
❑New ❑Repair/Replace UDemolition
al i3 ra c1
Color thru tile:
******************** ** **** x***** ******* Fees***** ***** ********* ***************** ********
a
Submittal Fee $ Permit Fee $
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
o
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
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
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 FT.ECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOP .ERS, 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 approved and a reinspection fee will be arged.
Signature
Owner orient
�rr Contractor
The foregoing instrument was acknowledged before me this d"]° The fore`g�' g instrument was acknowledged before me this
day of �2 .Q, , 20 U, by 41'(lr �® Va, Q-9 , day of ,/ Q� , 20 117, by J �s 0
who is personally known to me or who has produced who is personally known to 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:
My Commission Expires:
Nary Avila
COMMISSION# EE003683
:k EXPIRES: JU,.17,2014
°�` •mw.AAR0NNOTARY022
NOTARY PUBLI "as er Nery Avila
It COMMlssioN# EE003683
E FiRES: JUL. 17,2014
g r�.:o
Sl n: �v�. aae� vdwW.AARONNOTARi'.eato
Print
My Commission Expires:
:x******** ******** * * * ** **: ** ***: x******* **************** ************ ********** x****: x*: x*************x*** **
APPROVED BY
A-F-ef
Plans Examiner
Zoning
Structural Review Clerk
(Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06/10 /2009)(Revised 3/15/09)
Construction Qualifying Board
BUSINESS CERTIFICATE OF COMPETENCY
11 BS00347
SAMADA FENCE INC
D.B.A.:
MADA SERGIO MARCIAL
Is certified under the provisions of Chapter 10 of Miami -Dade County
044
FIRST -CLASS
US. POSTAGE I
PAID
MIAMI, FL
PERMIT NO. 231
THIS IS NOT A BILL — DO NOT PAY
RECEIPT NO. 30- 7151194 CC NO: 11 BS00347
BUSINESS NAME / LOCATION
SAMADA FENCE INC
110 W 31 ST
OWNER :SAMADA FENCE INC'
RECEIPT HOLDER MAY DO
BUSINESS AS A CONTRACTOR
AS SPECIFIED HEREON.
SEE BACK OF RECEIPT FOR
A LIST OF NONPARTICIPATING
MUNICIPALITIES
Receipt holder must
register in the city
where work Is to be
done.
wwwwwW.colm
M ANU -DARE coUNTY TAX
co1*27/2012
02250003001
000175.00
SPECIALTY BUILDING CONTRACTOR
DO NOT FORWARD
SAMADA FENCE INC
SERGIO SAMADA PRES
110 W 31 ST
HIALEAH FL 33012
hah n l>Ii tt► rrfr JlttlJJti.ltduttltiiftu dillmtli !!
BU INE3ShI At h / LOCATION
SAMADA FENCE INC
110 W 31 ST
33012 HIALEAH
OWNER q u g �F4
seer laE INC
FIRST -CLASS
U.S. POSTAGE 1
PAID
MIAMI, FL
PERMIT NO. 231
THIS IS NOT A BILL - DO NOT PAY
R I EWAL
715119 -4
CC # 11BS00347
THIS IS 11616 ASIALTY BUILDING CONTRACTOR
BUSINESS TAX RECEIPT. IT
DOES NOT PERMIT THE
HOLDER TO VIOLATE ANY
EXISTING REGULATORY OR
ZONING LAWS OF THE
COUNTY on cITIES. NOR
DOES IT EXEMPT THE
HOLDER FROM ANY OTHER
PERMIT OR LICENSE
REQUIRED BY LAW. THIS IS
NOT A CERTIFICATION OF
THE HOLDER'S QUALIFICA-
TIONS.
PAYMENT RECEIVED
ummomm COUNTY TAX
cmucmm
09/26/2012
09010109001
000045.00
SEE OTHER SIDE
WORKER /S
1
DO NOT FORWARD
SAMADA FENCE INC
SERGIO SAMADA PRES
110 W 31 ST
HIALEAH FL 33012
I,I11T1dhPliMMM1Mf1t1Ii(i('il
IH1d1I/ IMf�r1C'79A
206
03 -14 -2012
JEFF ATWATER STATE OF FLORIDA
CHIEFFINANCIALOFFICER 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:
PERSON:
FEIN:
05/12/2012 EXPIRATION DATE: 05/12/2014
SAMADA SERGIO M
204936039
BUSINESS NAME AND ADDRESS:
SAMADA FENCE INC
DBA SAMADA FENCE, INC
476 E 62 ST
HIALEAH FL 33013
SCOPES OF BUSINESS OR TRADE:
1- FENCE ERECTION -METAL 2- FENCE ERECTION
*
IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this
section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the
scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(131, 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 an the notice or
certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person
named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE
STATE OF FLORIDA
DEPARTMENT OF FINANCIAL SERVICES
DIVISION OF WORKERS' COMPENSATION
CONSTRUCTION INDUSTRY
CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA
WORKERS' COMPENSATION LAW
EFFECTIVE 05/12/2012 EXPIRATION DATE: 05/12/2014
PERSON: SERGIO M SAMADA
FEIN: 204936039
BUSINESS NAME AND ADDRESS:
SAMADA FENCE INC
DBA SAMADA FENCE, INC
476 E 62 ST
HIALEAH, FL 33013
SCOPE OF BUSINESS OR TRADE
1- FENCE ERECTION -METAL 2- FENCE ERECTION
IMPORTANT
F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who
elects exemption from this chapter by filing a certificate of election
L under this section may not recover benefits or compensation under this
D chapter.
Pursuant to Chapter 440.05(12), F.S., Certificates of election to be
H exempt.. apply only within the scope of the business or trade listed on
Rthe notice of election to be exempt.
E 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 meets
the requirements of this section for issuance of a certificate. The
department shall revoke a certificate at any time for failure of the
person named on the certificate to meet the requirements of this
section.
QUESTIONS? (850) 413 -1609
CUT HERE
* Carry bottom portion on the job, keep upper portion for your records.
DWC -252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11
Ciient#:1452573
132SAMADFEN
ACORD,. CERTIFICATE OF LIABILITY
INSURANCE 1 DATE(MNWDIYYYII
6/11/2012
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(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 lieu of such endorsement(s).
PRODUCER
BB &T- Oswald Trippe and Company
2200 N Commerce Pkwy, Ste 204
Weston, FL 33326
954 389-1289
NAACT
gNo, , 954 389 -1289 I t,, No): 8664024684
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIL #
INSURER A: Bankers Insurance Company
33162
INSURED
Samada Fence Inc
Sergio
110 West 31st Street
Hialeah, FL 33012
INSURER B : Hartford Casualty Insurance Com
29424
INSURER C :
08/07/2013
INSURER D :
$1,000,000
$100,000
INSURER E :
INSURER F:
MED EXP (Any one person)
COVERAGES
CERTIFICATE NUMBER:
•
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN BYpPAIIyDgCLAIMS.
L"
TYPE OF INSURANCE
INNa°�RLSUJBR
POLICY NUMBER
pRQELDIJC�EDD
(fII1D lYYYY)
(Rl4IDD7YYYY)
LINOS
A
GENERAL
LIABILITY
COMMERCIAL GENERAL LIABILITY
090005332537605
06 /07/2012
08/07/2013
EACH OCCURRENCE
$1,000,000
$100,000
PREM ISES {Ea occ�iarence)
CLAIMS -MADE I I OCCUR
MED EXP (Any one person)
$ 5,000
X
PD Ded:250
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
$1,000,000
GEM_ AGGREGATE LIMIT APPLIES PER
—1 POUCY IeI jPT Ii LOC
PRODUCTS - COMP/OP AGG
$
AUTOMOBILE
—
LIABILITY
ANY AUTO
AA U_ ED
HIRED AUTOS
_
AACUT ULED
NON -OWNED
AUTOS
COMBINED SINGLE UMIT
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
$
UMBRELLA LIAB
EXCESS LIAB
_
OCCUR
CLAIMS-MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED 1 RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVEY /N
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, escilbe under
DESCRIPTION OF OPERATIONS below
N / A
1 WC STAI J-S I I OTH-
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE - POLICY UMIT
$
B
Surety Bonds
21BSBEB4532
09/30/2011
09/30/2013
2,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space s required)
Fence Contractor
CERTIFICATE HOLDER
CANCELLATION
Miami Shores Village
Building Department 10050 NE 2nd
Avenue
Miami Shores, FL 33138
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
1988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S8729490/M8729457
LIGO
exrovr
FOUND 1/2"
IRON PIPE
0.4' WEST
0.3' SOUTH
REMAINDER OF
LOT 22
BLOCK 22 •
(NOT INCLUDED) 11)
N
■ommanacr
t
;9'51
0.5'
WOOD
FENCE
ASPHALT
PAVEMENT
•
•
4' C.L.F.
15.0'
LOT 23
BLOCK 22
73.50
39.13'
BUILDING
#151
2.444)
10.1'
20.35'
PLANTER
EAST 1/2 OF
LOT 22
BLOCK 22
(INCLUDED)
FOUND 1/2"
IRON PIPE
90'0802 "(C)
25.00'
89'51.58 (M)
50.00'
• .5' S
ASPHALT -
PAVEMENT_
SURVEY NOTES
CONCRETE DRIVE
PROPERTY BOUND
NORTHERLY SIDE OF LOT
THERE ARE FENCES
NEAR THE BOUNDARY
OF THE PROPERTY
NORTHEAST 93rd STREET
75' R /W(P)
(IMPROVED).
W
LLJ
LL
0_
•
(SIGNED)
PAGE 2 OF 2 PAGES
BOUNDARY SURVEY
SURVEYORS CERTIFICATE
1 HEREBY CERTIFYTHAT THIS BOUNDARY SURVEY
ISA TRUE AND CORRECT REPRESENTATION OF A
SURVEY PREPARED UNDER MY DIRECTION.
NOT VALID WITHOUT AN AUTHENTICATED ELECTRONIC
SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL,
OR A RAISED EMBOSSED SEAL AND SIGNATURE.
Digitally signed by Clyde
MCNaaI
DN: CN = Clyde McNeal, C=
US, O =Target Surveying, Inc.
Date: 2012.10.1715:43:15 -
04'0='
Clyde
McNeal
CLYDE O. MONEAL, PROFESSIONAL SURVEYOR AND MAPPER #2883
LB #7893
TARGET
SURVEYING, rrc
SERVING ALL FLORIDA COUNTIES
6250 N. MILITARY TRAIL, SUITE 102
WEST PALM BEACH, FL 33407
PHONE (561)640 -4800
FACSIMILE (561) 640 -0576
STATEWIDE PHONE (800) 226 -4807
STATEWIDE FACSIMILE (800) 741 -0576
•
o Shadow Box
o Vertical Picket
o Board on Board
Miami Shores Viiiage
Building Department
WOOD FENCE DETAIL
4x4 Post Spacing
Fences <= 5' high posts spaced at 5'on center maximum
Fences <= 4' high posts spaced at6"on center maximum
Fence must not exceed 5' in height
May 2009
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
4x4 pressure treated
posts embedded Tinto
concrete footing 10"
diameter x 2'deep
ALL wood must be pressure treated
All fasteners must be corrosion resistant
No Tess than two fasteners in any connection
2x4 horizontal
pressure treated
wood members
with two corrosion
resistant fasteners
per connection
The East 1/2 Lot 22 and Lot 23, Block 22, MIAMI SHORES SEC77ON 1, accordng to the Plat thereof, as recorded in Plat Book 10, Page 70, of the Public Records of
MIAMI -DADE County, Florida
Community Number :: 120652 Panel 0093 Suffix JFlood Zone: XFieki Work 10/16/2012
Certified To:
ALFREDO VALDES JR. AND DIEGO A SUAREZ STAR TITLE SOLUT IONS, INC.; OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY; BANK OF AMERICA NA,
its successors and/or assigns
Property Address:
151 NE 93 STREET
MIAMI SHORES, FL 33138
Survey Nurnber. 181389
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PAGE t OP 2 PANS
LEGAL DESCRIPTION AND CERTIFICATION
armen
hofi CT fA iVTsCV7G IER
IT ta1tT
OPER
7r 61 AVD A27TTOBE USED Iv REnnisracr
LB #7893
SG, LIC
SERVING ALL FLORIDA COUNTIES
PEET DMMUSREARMS)TOA'OV'F.7P�
TIMMlfAV'E BEEN ErvISGE9 ED TO OWE
PHYSYCAL A47A' LOT LBWS
8thaMONOFTit€ IliVREATVOITS OVER
6250 N. MILITARY TRAIL, SUITE 102
WEST PALM BEACH, FL 33407
PHONE (561) 640-4800
FACSIMILE (561) 640-0576
STATEWIDE PHONE (800)226-4807
STATEWIDE FACSIMILE (800) 741-0576
PERMIT #�, I 0,- 2,44-1
C,-,- . A ,-..dri
CONTRACTOR:
SUBMITTAL DATE: 1 21)12,
ADDRESS: 1l 1
6S--1-
NAME:
RESUBMITAL DATES:
PROJECT TYPE: t) 0 (, ' 11Afic.
/ .
ZONIN t
FIRE
STRUCTURAL
IMPACT FEES
ELECTRICAL
HRS/DERM
PLUMBING
NOC
IECHANICAL
BLDG