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FW-16-2677Project Address Miami Shores Village 10050 N.E. 2nd Avenue N Miami Shores, FL 33138-0000 Phone: (305)795-2204 Parcel Number It i ype Fen nfalti ss on: Wood Fence p+ ri Staff: APPROVED Expiration: 06/25/2017 Applicant 9125 N BAYSHORE Drive Miami Shores, FL 33150- 1132050010590 Block: Lot: MARK & DARLENE HUTCHINSO Owner Information Address Phone Cell MARK & DARLENE HUTCHINSON 9125 N BAYSHORE Drive MIAMI SHORES FL 33138- (786)712-2347 Contractor(s) GOMEZ & SON FENCE Phone (305)471-8922 CeII Phone Valuation: Total Sq Feet: $ 1,000.00 18 Approved: Comments: Date Approved: : Date Denied: Type of Construction: Wood Fence Classification: Residential Additional Info: REPAIRING 2 WOOD GATES EXIST Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Notary Fee Permit Fee - Wire & Wood Scanning Fee Technology Fee Amount $0.60 $2.00 $2.00 $0.20 $5.00 $100.00 $3.00 $0.80 Total: $113.60 Pay Date Pay Type Amt Paid Amt Due Invoice # FW -9-16-61521 09/29/2016 Check #: 4940 $ 50.00 $ 63.60 12/27/2016 Check #: 5360 $ 63.60 $ 0.00 Available Inspections: Inspection Type: Final Review Planning Review Building 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: construction and zonin Auth . Builds ature: the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating authorize th above-named contractor to do the work stated. / Applicant / Contra or / Agent ent Copy December 27, 2016 Date December 27, 2016 1 nvA\ cyg5c(' 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 BUILDING PERMIT APPLICATION IA BUILDING ❑ ELECTRIC ❑ ROOFING ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS JOB ADDRESS: City: `Miami Shorres�^ ��-g/.)C�olunty: �r OS Folio/Parcel#: ! J - 3( O/ Occupancy Type: RECEIVED SEP 292916 gth FBC 201 IL Master Permit No. -('V `i ` lU + Zvi Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ CHANGE OF CONTRACTOR G l --S 1 u- 6 ofrti ofd )r: v Q ❑ CANCELLATION ❑ RENEWAL ❑ SHOP DRAWINGS Miami Dade Zip: Is the Building Historically Designated: Yes Load: Construction r�� nnjL Type: Flood Zone: BFE: ��W^� ^� OWNER: Name (Fee Simple Titleholder): ti badsfluk�1;Y�S ,-) Phone#: 138 NO X FFE: Address: City: �t/ Tenant/Lessee Name: !/ A Email: 1Y /(� << Ce (Y11 SState:rcreS Phone#: Zip: 33/38 I CONTRACTOR: Company Name: e L Jct') r? t=Q COr Address: (Dg&' ,"V&) City: A4 State: Qualifier Name: L,.' d4C 1 'r)'P 2 State Certification or Registration #: DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ Type of Work: ❑ Addition /7)-6'6—P P Phone#: C9?fwY/ Zip: 33/7,3 /73 Phone#: Certificate of Competency #: Phone#: City: State: Zip: Square/Linear Footage of Work: ❑ Alteration n New ❑ Repair/Replace n Demolition ti Description of ork: A ei 40 52)4i& ) 1;1\ 030 6 ,,-v\‘ I -z(0(-1 for ,l'o' �fM Specify csoitetf color thru'tile:' �� f)•• ' Permit Fee $: \3 Radon Fee $ 2 •c\\ Submittal Fe Scanning Fee $ Technology Fee $ Structural Reviews $ (Revised02/24/2014) CCF$ 60 DBPR $ "CA Training/Education Fee $ ` 20) CO/CC $ Notary $� U Double Fee $ Bond $ TOTAL FEE NOW DUE $ 6 • SC) 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 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 hrnrhure will he delivered to the percnn whose property is subject to attachment. Also, a certified copy of the recorded notice of c• mencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is iss . d. 1 the absence of such posted notice, the inspection will not be approved and a reins. - - will be charged. Signatur OWNER or AGENT The foregoing instrument was acknowledged before me this / ( day of bf .20 l by ago who is p onaliy n n to me or who has produced identification and who did take an oath. NOTARY PUBLIC: 0; Sign: `y *IIIb�� Print: �� a 0 � 1-•.......M�•. q %y Print: 18 = : eo :tel $ Seal: ?� ���1.4 11 s Seal: f sin: cn= 29 �y` g 6 •N / APPROVED BY �B �I %I ��NII 111plans Examiner as Signature NTRACTOR The foregoing in ` ument" as acknowledged before me this Z1 day of , 20 tip , by Cored 6DMe,7, eho ispersonally known to') me or who has produced as identification and who did take an oath. NOTARY PUBL (Revised02/24/2014) Structural Review ISABEL PANEOUE ,E Notary Public - State of Florida 1 Commission # GG 013517 My Comm. Expires Jul 23, 2020 ******* Zoning Clerk 000764 Municipal Contractor's Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7150378 BUSINESS NAME/LOCATION CARIDAD GOMEZ, GOMEZ & SON FENCE - 10805 NW 22 ST SWEETWATER FL 33172 OWNER GOMEZ & SON FENCE Category(s) CARIDAD GOMEZ PRES e8 ry( ) 000832 RECEIPT NO. NEW 7498997 MC EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art 9 & 10 SEC. TYPE OF BUSINESS MMC SPECIALTY BUILDING CONTRACTORPAYMENT RECEIVED BY 000016587 TAX COLLECTOR $200.00 11/30/2016 FPPU01-17-000313 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit or a certification of the holders qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec Ba -278. For more information, visit www.miamidade.govhaxcollector Local Business Tax Receipt Miami—Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7150378 BUSINESS NAME/LOCATION CARIDAD GOMEZ, GOMEZ & SON FENCE 10805 NW 22 ST SWEETWATER FL 33172 OWNER GOMEZ & SON FENCE C/O CARIDAD GOMEZ PRES Worker(s) 10 RECEIPT NO. RENEWAL 1496215 LBT EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 SEC. TYPE OF BUSINESS 196 SPECIALTY BUILDING CONTRACTOR 000016587 PAYMENT RECEIVED BY TAX COLLECTOR $45.00 09/30/2016 CREDITCARD-16-060675 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, remit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec Ba -276. For more information, visit www.miamidade.gov/laxcollector 000832 Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT A BILL — DO NOT PAY 7150378 BUSINESS NAME/LOCATION CARIDAD GOMEZ, GOMEZ & SON FENCE 10805 NW 22 ST SWEETWATER FL 33172 OWNER GOMEZ & SON FENCE C/0 CARIDAD GOMEZ PRES Worker(s) 10 RECEIPT NO. RENEWAL 1496215 LBT EXPIRES SEPTEMBER 30, 2017 Must be displayed at place of business Pursuant to County Code Chapter 8A — Art. 9 & 10 SEC. TYPE OF BUSINESS PAYMENT RECEIVED 196 SPECIALTY BUILDING CONTRACTOR BY TAX COLLECTOR 000016587 $45.00 09/30/2016 CREDITCARD-16-060675 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles — Miami—Dade Code Sec 8a-276. For more information, visit www.miamidado.gov/taxcollector 2017 Paid 2016 2015 2014 Account number: 7150378 Business start date: 05/17/2013 Physical business location: SWEETWATER Paid Paid Paid Business address: CARIDAD GOMEZ, GOMEZ & SON FENCE 10805 NW 22 ST SWEETWATER, FL 33172 Mailing address: Owner(s) p] Print account application (PDF) Receipts And Occupations GOMEZ & SON FENCE CIO CARIDAD GOMEZ PRES 10805 NW 22 ST SWEETWATER, FL 33172 GOMEZ & SON FENCE C/O CARIDAD GOMEZ PRES 10805 NW 22 ST SWEETWATER, FL 33172 Receipt 1496215 Contracting 10/01/2016— NAICS code: pi Print this SPECIALTY BUILDING 09/30/2017 j 238990 bill CONTRACTOR Units: 10 Documentation Required by Occupation: State/County License or Certificate Document Received: 000016587 Receipt 7498997 Non-renewable Multi -Municipal Contractor 11/23/2016— Y SPECIALTY BUILDING 09/30/2017 CONTRACTOR FENCING Units: 1 Print this bill Documentation Required by Occupation: Certificate of competency number or state registration number. Document Received: 000016587 4 r CTB Construction Trades ualitying Board BUSINESS CERTIFICATE OF COMPETENCY 000016587 GOMEZ & SON FENCE D.B.A. GOMEZ'CARIDAD Is certified under the provisions of Cha er t 0 of Miami -Dada County QUALIFYING TRADE(S) 0018 FENCE Policy Number: 3ED3108 Date Entered: 0 02 / 2016 ACORiff �� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 11/30/2016 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thls certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER KEY KNOWLEDGE INSURANCE, INC. 9101-C S. W. 19TH. PLACE FORT LAUDERDALE, FL. 33324 CONTACTCOMMarla R a1s Y PHONE Est): 382-5259 FAX NNo):(954) 382-0080 . ADDE-MAIL REss:mryals@keyknowledgeins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ESSEX INSURANCE COMPANY AXIV NAIC 3533$378 COMMERCIAL GENERAL LIABILITY INSURED Caridad Gomez dba Gomez and Son Fence 10805 NW 22 ST MIAMI, FL 33172 INSURER B : BURLINGTON INSURANCE COMPANY AIX 23620 INSURER C : 05/14/2017 INSURER D : $ 1, 000 , 000 INSURERE: INSURER F : DAMAGE TO D PREMISES (Ea occu ence) COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TR TYPE OF INSURANCE jJSD SUBR POLICY NUMBER ( POLICY EFF MMIDD/YYYI) POLICY EXP (MM/DD/YYYY) LIMITS A COMMERCIAL GENERAL LIABILITY X X 3ED3108 05/14/2016 05/14/2017 EACH OCCURRENCE $ 1, 000 , 000 CLAIMS -MADE X OCCUR DAMAGE TO D PREMISES (Ea occu ence) $ 100,000 1000 DEDUCTIBLE MED EXP (Any one person) $ 5 , 000 1000 DEDUCTIBLE PERSONAL 8, ADV INJURY $ 1,000,000 $ 2 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES POLICY X SEOa OTHER: PER: LOC GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ 2 , 000,000 $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY N/A COMBINED SINGLE LIMB (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B XEXCESS UMBRELLA LIAB LIAB X OCCUR CLAIMS -MADE HFF0003492 05/14/2016 05/14/2017 EACH OCCURRENCE $ 5,000,000 $ 5,000,000 AGGREGATE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEN/A OFFICER/MEMBER EXCLUDED? (Mandatory In NH) Hyes, describe under DESCRIPTION OF OPERATIONS below Y/N N /A PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required) 14-029R Supply, Install and Repair Chain Link Fencing " This policy contains blanket additional insured and waiver of subrogation " LICENSE # 000016587 CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2 Avenue Miami Shores Village, FL. 33138 ACORD 25 (2016/03) 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 MARIA A. RYALS, AGED © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Producedusing Forms Boss Plus software.www.FormsBoss.comlmpressivePublishing 800-208-1917 A� D° CERTIFICATE OF LIABILITY INSURANCE TE 11�2/D2o� THIS CERTIFICATE 15 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: H 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 Gil, Garden, Avetrani Insurance GroupNaEXo, 10689 N. Kendall Drive Suite 208 Miami FL 33176 CONTACT Martha Salazar NAME: (305) 630-4777NucNo): 1305)279-3022 A ss,msalazar@ggaig.com INSURER(8) AFFORDING COVERAGE NAIC N INSURER A Bridgefield Employers Ins. Co. 10701 INSURED Caridad Gomez; Gomez & Son Fence P 0 Box 226915 Miami FL 33222 INSURER B INSURER C: INSURERD: $ INSURER E : CLNMS h1ADE INSURER F : OCCUR COVERAGES CERTIFICATE NUMBER:CL164108321 REVISION NUMBER: 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED PAID CLAIMS. LTR TYPE OF INSURANCE ADM INSD sUBR MD POLICY NUMBER FFBY si�DIYYYYI (M�M?DWYYY I LIMA COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLNMS h1ADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY_ $ GEN'L AGGREGATE LIMIT APPLIES POLICY [ 1 J Ra- OTHER: PER LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS — SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTIONS 8 A WORKERS COMPENSATION..„PER AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) H yes describe under DESCRIPTION OF OPERATIONS below Y / N N N / A 0830-15681 4/1/2016 4/1/2017 OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000 , 000 E.L. DISEASE - EA EMPLOYEE $ 1, 000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached N more space is required) CONTRACTOR'S LICENSE CTQB # 000016587 14-029R SUPPLY, INSTALL, AND REPAIR CHAIN LINK FENCING CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTMENT 10050 N.E. 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 Frank Gil/MS '43rAvedvegsg ‘gr -€7.e. ACORD 25 (2014/01) INS025 r�rltenn © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD