FW-12-455Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 171185
Scheduled Inspection Date: August 30, 2012
Inspector: Bruhn, Norman
Owner:
Job Address: 10500 BISCAYNE Boulevard
Miami Shores, FL 33138-
Project <NONE>
Contractor: ATELIER & PROJECTS LLC
Permit Number: FW- 3- 12-455
Permit Type: Fence/Wall
Inspection Type: Final
Work Classification: Iron/Ornamental
Phone Number
Parcel Number 1122300010500
Phone: (786)306 -7900
Building Department Comments
3 GATES 6' HIGH WITH
Inspector Comments
Passed
et—
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
August 29, 2012
For Inspections please call: (305)762 -4949
Page 1 of 18
I2 -I\iz A400
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
Permit No. Rol — L155
Master Permit No.
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: BUILDING
ROOFING —
OWNER: Name (Fee Simple Titleholder).
Address: / .5-6249 ,/ P 5‹ ,u-e._ ,,g/ c® a
City: F e?- --se c--'(__5:4)€5
State: ,1- - Zip:
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: /O $D t )fie A lye ,
City: Miami Shores
Folio/Parcel #:
Phone#: 1'7 3-72 9/
tt/ b -3)s Si (aZ
71/3,
County:
Miami Dade
Zip: 3 3 l 3 e
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name: T r %4-/0 1 1R
EX Address: • " Al W , Cam/ lii vr1 ?Y7 ciij e
City: 1 V ; T 1 State: f` 1--, Qualifier Name: S. kw Po 6 P 6
State Certification or Registration #: (� Cf /� Pq �i0`7
Contact Phone#: q cr' y ' ..,,o, 24-33Email Address:
of &C7 Phone #: 95 `• �o3 "2,5'x.3
Zee
4-PT-P.! '1 7 &2&
I ee)
Phone #: - ! v y' - 2 �
Certi 1lcate of Competency #:
DESIGNER: Architect/Engineer: Phoife #:
j !
Value of Work for this Permit: $ P , 672 ®� Square/Linear Footage of Work:
Type of Work: DAddition DAlteration I INew;.
Description of Work: �� re.-9
DRepair/Replace
?eA'
DDemolition
* ***** ** ***** *************************Fees************** * *** ***, **************** **
cv
Submittal Fee $ Permit Fee $ `C/a CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ ��yy77 e73 Training/Education Fee $ Technology Fee $
Double Fee $ /2ej Structural Review $
TOTAL FEE NOW DUE $ 2.,,�Q "
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 ELECTRICAL 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 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 t the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of comyence ust be poste' at t e job site
for the first inspection which occurs seven (7) days after the building permit is issued
inspection will not be approved and a reinspection fee will be charged.
Signature
Owner or Agent
ment was ackno
The f.rego
day o
ged befo
is
Signature
notice, the
Contractor
The foregoin instrument was acknowledged before me this 1°_
ay of 1 (-r , 20 1Z, byEaCP 10 004. ,
ho is personally known to me or who has produced 0
as identification and who Al i4al ieriT oath.
, ‘ \::: .
i
Rrl0n /.^ /0,,,
,�p,�: •./ goy °�, �':
C ;;
^'' who i vrsgqonally kno to me or who has produc
"LU. I ' 11 '�1�dentification and who did take an oath.
NOTA
Sign:
Print:
YJUBLIC:
My Commission Expires:
* * * * * * * * * * * * * * * * * * * * * * * **
NOTARY PUBLIC-
Sign:
Print:
My Commission Expires:
***********************************+**** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPROVED BY Plans Examiner
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Zoning
Clerk
08/28/2012 12:08 8548775225
RAINBOW INSURANCE *5597 P.001/001
I;) � CERTIFICATE OF LIABILITY INSURANCE ` 9 /112
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 colt-haste holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WANED, subject to
the term and conditions of the policy, certain p011Cies may require an endorsement A statement on this certificate does not Confer rights to the
certificate holder in Rep of such endorsement(s),
PRODUCER . CO d1 YULIA GONZALEZ
LNAtdie:
Rainbow Insurance, Inc. 'PHONE (954) 977 -0047 I (A c. Not: (954) 977-5004
1344 N. State Road 7 •Egg, les@rainbowinsurance.t:om
Margate, FL 33063 I INSURERS) AFFORDING COVERAGE
Phone (954) 977 -0047 Fax (954) 977-5004 I INSURER A: ACCIDENT INSURANCE COMPANY
INSURED !- INSURERS I
& PROJECTS ' INSURER C :
ATELIER ;_..
5
20400 VV Country Club or Ap t #519 . INS URER 0:
' IIS ` URERE'
(305) 239-3757
INSURER F :
j AVENTURA, FL 33180•
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 wmi 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 IAPOLSUER PQIICY PO Exp. LJedITS
Lr R . TYPE OF INSURANCE INSR • WVD � pQuCY NUMBER NI( mtOD11I11YY) ; ( IYVDD/YY)
GENERAL LIABILITY i EACH OCCURRENCE ,. ! $ 2,000,000.00
• Vi COMMERCIAL GENERAL LIA M.rrY PPREMIISES (EaaE RENTED , I' S 100,000.00
• CLAIMS -MADE k OCCUR i CPP000167500 MBD EXP (Any one person) 1 5 000.00 ;
i A — I 03/27/2012 ' 03/27/2013 '
PERSONAL &ADVINJURY . $ 1,000,000.00
L I ., I I GENERAL AGGREGATE 1$ 2,000,000.00
' GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG i $ 21000.000.00
1 I$
NAIC #
;.- POLICY • i EGT • LOC
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED ULED
AUTOS AUTOS
Nb D
HIRED AUTOS ALros
– . UMBRELLA W.S L 1 OCCUR
J EXCESS UAB CLAIMS -MADE
i! DED _ RETENTION$ •
i WORKERS COMPENSATION
I AND EMPLOYERS' ',ARMY Y Y/ N;
ANY PROPRIETOWPARTNER/EXECUTNE I
• OFFICER/MEM$ER EXCLUDED? j N / A
, (Mya�nsdatory In NN) I I
• DESCRIPTION ON OOF•OPERATIONS belmm
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Seeedele, R more space Is reelArad)
GENERAL CONTRACTO LIABILITY
CERTIFICATE HOLDER
CITY OF MIAMI SHORES
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
ACORD 25 (2010/05) OF
CANCELLATION
CEs OMBINED SINGLE miff $
BODILY INJURY (Per person) ' $
$ODILY INJURY (Pet accident] 5
per accident) E
I EACH OCCURRENCE $
AGGREGATE $
i $
WC STATU- H-
OT
1 TOBYJJN. n_LI ER 1 .. _.
I E.L EACI-IACCIDENT ! S
I E.L. DISEASE - EA EMPLOYEE 5
E.L. DISEASE • POLICY LIMIT 5
• SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I
THE EXPIRATION DATE THERE • - • EUVERED IN
ACCORDAN !. - ' ■ CY PROVISIONS.
TION. "rights reserved.
ORD name a istered marks of ACORD