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ELC-16-3345 Permit NO. ELC-12-16-33145 �s�°REs r,4 Miami Shores Village Permit Type:Electrical -Commercial 10050 N.E.2nd Avenue NE Work Classification:Low Voltage Miami Shores, FL 3313&0000 Per iPermit Status:APPROVED F°"-mayPhone: (305)795-2204 GORtDA Issue Date: 1 2/1 31201 6 Expiration: 06/11/2017 Project Address Parcel Number Applicant 11300 NE 2 Avenue 1121360010160 Miami Shores, FL 33138- Block: 1 Lot: 2 BARRY UNIVERSITY INC Owner Information Address Phone Cell BARRY UNIVERSITY INC 11300 NE 2 Avenue MIAMI SHORES FL 33161-6628 11300 NE 2 Avenue MIAMI SHORES FL 33161-6628 Contractor(s) Phone Cell Phone Valuation: $ 70,000.00 DELPHI ONE SYSTEMS CORP (305)593-9601 (786)258-9605 . _ __...._.... .M.._.,...... _.._ _ Total Sq Feet: 0 Type of Work: INSTALLATION OF 46 IP SECURITY CAME Available Inspections: Additional Info: INSTALLATION OF 46 IP SECURITY CAME Inspection Type: Classification:Commercial Review Electrical Scanning:5 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $42.00 DBPR Fee Invoice# ELC-12-16-62324 $31.50 12/12/2016 Credit Card $50.00 $2,240.00 DCA Fee $31.50 Education Surcharge $14.00 12/13/2016 Credit Card $2,240.00 $0.00 Permit Fee $2,100.00 Scanning Fee $15.00 Technology Fee $56.00 Total: $2,290.00 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 acceptingthis permit I sume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, LUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AF DAVIT: I i that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction n zoning. F r re, I authorize the above-named contractor to do the work stated. December 13, 2016 Autho nat Owner / Applicant / Contractor / Agent Date Building epartment Copy December 13, 2016 1 2 13 l� rlf3y: CEIVED1 � Miami Shores Village DEC 12 2016Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 1 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2014 BUILDING Master PermitNo.c,,k—C I2- �6- 534_6 PERMIT APPLICATION Sub Permit No. ❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: CAMPUS - SECURITY CAMERAS 1 0() We 2r� City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):BARRY UNIVERSITY Phone#:305.899.3995 Address: 11300 NE 2ND AVENUE City: MIAMI SHORES State: FL Zip; 33161 Tenant/Lessee Name: Phone#: Email: Jyao@barry.edu CONTRACTOR:Company Name: DELPHI ONE SYSTEMS CORP Phone#: 305 593 9605 Address: 7311 NW 12 Street# 16 City: Miami State: Florida Zip; 33126 Qualifier Name: Francisco Rodriguez Phone#: 786 258 4230 State Certification or Registration#: EG-13000224 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: _ g� City: State: Zip: Value of Work for this Permit:s��'� 3d1 OM f Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑■ New ❑ Repair/Replace ❑ Demolition Description of Work: Installation of 54 IP security cameras Specify color of color thru tile: Submittal Fee$ Permit Fee$ l 104, '01d5 6 CCF$ � CO/CC$ Scanning Fee$ (4J ' ,,^� Radon Fee$ �)•�Jl) �DLBPR$ �� Notary$ l,• Technology Fee$ ffi . Training/Education Fee$ T Double Fee$ Structural Reviews$ Bond$ 16 TOTAL FEE NOW DUE$ .2.42-40-0 (Revised02/24/2014) 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 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 th absenceof such posted notice, the inspection will not be approved and a reinspection fee will be charged. C, — Signature i Am S11A A 4 4 Signature OWNER or AGENT CO ACTOR The f egoing instrument was/acknowledged before me this The foregoing instrument was acknowledged before me this 9 day of PV, GR- 20 16 by � day of b20 ( (o by Susan Rosenthal who is personally known to 71ZAOG-'-� "-�"ODrUr-CJI Zho is personally known to me r who has produced as me or who has produced as identification and who did take an oath. identification a o did take an oath. NOTARY PUBLIC: NOTARY PUB IC: Sig v Sign: Pri Print: car Notary Public Stats of FlorIAa Rkw*A,Lash Se _ Seal: ' My Coommluion FF 188481 NOTARY OF FLORIDA a Expirn 11/12/2018 Cam"FF9200 APPROVED BYii;� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) ♦SNoR�s c� loss J .,...M Miami Shores Village Building Department OR[Dp' 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A.�OPY OF QUALIFIER'S STATE LICENCES B. 1,--'-COPY OF LOCAL BUSINESS TAX RECEIPT C. G/ COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME: 'DEL ,141 ONE COiZ-P BUSINESS ADDRESS: 9 3 II NW 12 S7 -41(0 CITY P<A M I STATE F(- ZIP 3312-(o BUSINESS PHONE: ( 30! ) S92 960SO - FAX NUMBER(30S ) S73 Cl G01 CELL PHONE�`7�(0) ZS$ Q Z3O QUALIFIER'S NAME: �rG✓�ctScO IGOc�rl q U 2 Z �- QUALIFIER'S LIC NUMBER: �c 13 ObC) 22 T STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 RODRIGUEZ, FRANCISCO J DELPHI ONE SYSTEMS CORP 7311 NW 12TH STREET SUITE 16 MIAMI FL 33126 Congratulations! With this license you become one of the nearly - - - -- - - one million Floridians licensed by the Department of Business and , Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque D DEPARTMENT-OF BUSINESS AND restaurants,and they keep Florida's economy strong. PROFESSIONAL REGULATION r ,.. r Every day we work to improve the way we do business in order EG13000224p,,".j ,ISSUED:,'"09/07/2016 to serve you better. For information about our services,please l 1 r :; i log onto www.myfloridalicense.com. There you can find more CERT ALARMI SYSTEM1ONTRACTOR II ! information about our divisions and the regulations that impact RODRIGUEZ,FPANCISGO J you,subscribe to department newsletters and learn more about 'DELPHI ONE SYSTE48 CORP ` the Department's initiatives. - r 3/ Our mission at the Department is:License Efficiently, Regulate '• -y�'_T.- n. Fairly.We constantly strive to serve you better so that you can - serve your customers. Thank you for doing business in Florida, iS.CERTIFIED under-the_piovisions of Ch.489 FS. - and congratulations on your new license! ,.,,_ExpirZondwe"AUG 31.2018—_ _0609070001846 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY y - - - - - STATE OF FLORIDA' ` - ! -DEPARTMENT OF BUSINESS~AND PROFESSIONAL"REGULATION -ELECTRICAL.CONTRACTORS LICENSING BOARD 11G�13000224_ The ALARM SYSTEM CONTRACTOR It - - -_ Named below-IS CERTIFIED Under the provisions of Chapter.489-FS. Expiration date: AUG 31, 2018 -RODRIGUEZ,FIS RANCCO:) ` ,DELPHI ONE SYSTEM5,t'`O1tP= 7311 NW12TH'.9TREET SUITE'16>"""— - `"`"� ISSUED: 09/07/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1609070001846 0080W Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT A BILL—DO NOT PAY LBT 5477617 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES DELPHI ONE SYSTEMS CORP RENEWAL SEPTEMBER 30, 2017 7311 NW 12 ST 16 57173" Must be displayed at place of business MIAMI FL 33126 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED DELPHI ONE SYSTEMS CORP 196 SPEC ELECTRICAL CONTRACTOR -BY TAX COLLECTOR EG13000224 $75.00 07/16/2016 Worker(s) 1 CREDITCARD-16-041357 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. I The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec 6a-276. For more information,visit www.miamidade.godhoxcollector ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) A�O 12/12/2016 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 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 305-269-8988 888-652-7068 NAME:"CT MOC Poveda&Associates Insurance& Financial Moc, Poveda&Associates Insurance& Financial Services Inc. PHONE t.305-269-8988 a/c No:888-652-7068 5805 BLUE LAGOON DRIVE E-MAIL SS:kmoc@mpafinancial.com SUITE 140 INSURERS AFFORDING COVERAGE NAIC# MIAMI FL 33126 INSURER A:Maxum Indemnity Company 116138 INSURED 305-593-9605 Fax 305-593-9601 INSURER B:Maxum Delphi One Systems Corp INSURER C:Technology Insurance Company 11234 7311 NW 12 Street Ste 16 INSURER D: Miami, FL 33126 INSURER E: INSURER F: 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 ADDLSUBRTYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DDY� POLICY M DD/YYYY LIMITS LTR GENERAL LIABILITYEACH OCCURRENCE $1,000,000 A 1/ COMMERCIAL GENERAL LIABILITY PREM SESOEaLoccuence $100,000 CLAIMS-MADE V OCCUR BDG 0082743-03 07/15/2016 07/15/2017 MED EXP(Any one person) s5.000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 V( POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident UMBRELLA LIAB OCCUR07/15/2016 07/15/2017 EACH OCCURRENCE $2,000,000 B EXCESS LIAB CLAIMS-MADE BDG 0082743-03 AGGREGATE $2,000,000 DED I I RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N 09/23/2016 09/23/2017 10( C OFFICER/MEM ER/EXCLUDED?ECUTIVEANY NIA TWC-3576706 E.L.EACH ACCIDENT $1 OOO OOO (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1.000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Contractor License EG13000224 CERTIFICATE HOLDER Fa W5 CANCELLATION Miami Shores Village Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD