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ELC-15-2091 Miami Shores Village p AUG 2015 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 FBC 201 BUILDING Master Peit No. ��— �9 �✓ ` PERMIT APPLIC I sub P r ❑BUILDING 0 ELE n 4QJ�O;6FPG ❑ REVISION ❑ EXTEt�FZg�UEWAL ❑PLUMBING [:] MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: Weber Hall- Barry University- 11300 NE 2ND AVENUE 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#:305-899-4910 Address:11300 NE 2nd Avenue city. Miami Shoresstate: FL Zip: 33161 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: PRO SOUND INC Phone#: 305-891-1000 Address: 1375 NE 123RD ST City: MIAMI State: FL Zip: 33161 Qualifier Name: RODERICK SINTOW Phone#: 305-891-1000 State Certification or Registration#: ES0000149 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$24,000.00� quare/Linear Footage of Work: Type of Work: ❑ Addition ❑ "tf - 7 ❑ Repair/Replace ❑ Demolition Description of Work: INSTALLATION OF MULTIMEDIA EQUIPMENT Specify color of color thru tile: Submittal Fee$ Permit Fee$ �'�®�®® CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (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 the absence of such posted notice, the inspection will not be approved and a reinspection fee wil be charged. Signature Signature ladw) OWNER or AGENT I—CONTRAPOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 12th day of August 20 15 by 18th day of August ,20 15 by Susan Rosenthal who is personally knower Roderick Si ntow who is personally known to mg or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sig Sign: Print: Print:JSMINE PEREZ / oori PUW 9taN Ot RI ��ea a,,�� Seal: Jo(hyJ�+to Seal: ;g►.►""�• JASMINE PEREZ �wA� MYCen�mlulon PIR 199M1 Commission ii FF 58270 B�p►nr 11I1313o1P °� ��. My Commission Expires October 11, 2017 APPROVED BY ," �� ✓� Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION � � ELECTRICAL CONTRACTORS LICENSING BOARD _ ES0000149 The SPECIALTY ELECTRICAL CONTRACTOR Named below IS CERTIFIED �� VWT ' Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 AS A LIMITED ENERGY SYSTEMS SPECIALIST a � SINTOW, RODERICK JONATHAN a PRO SOUND INC 1375 NE 123 STREET MIAMI FL 33161=6525 U..A ISSUED: 07/24/2014 DISPLAY AS REQUIRED BY LAW SEa# L1407240001957 1 ORY89+� I �. cal-Business Tax Receipt Miami—Dade County, Stat- of Florida i —THIS IS NOTA GILL �00 NOT PAY i 4341723 BUSINESS NAMSAJOCATION R9CRIPT NO. EXPIRES ' PRO SOUND INC ✓RENEWAL SEPTEMBER 30, 2016 1375 NE 123 ST 3364510 NORTH MIAMI 1:t.33161 Most,Ira displayecl at place at'busii�es Pursuant to caunty,Codo Chapter SA—Art,9&10 I I OWNER SSC,TYPE OF BUSINESS PAVIVIENT RECEIVEO PRO SOUND INC 196 SPEC ELECTRICAL CONTRACTOR By TAX COLLECTOR worker(s) I$ ES0000t4g $69,00 D9/09/2014 CHECK21--14--063964 I This Loa]BusineTaxRoceipt only confirm-paymanl o!t Local FlusinessTax,The Receipt is oar a Ucensa, _ pera"t ora certification of the holder's ualificarl one to do businesu Neid in'esf tly wiA any gwomm+anraf or 000goveramentaf reoulatory laws apirequiromdnlc which apply m the 0,14nesa. Th®RECEIPT N0.above must Int displayed op 441 comm sal uehi4l wta-0e4o Cade Sac 6a-276. Far more Inturmalien,visit t tel rlltla Ag' d1 l PROSOUN-03 LGLEASON '4co CERTIFICATE OF LIABILITY INSURANCE DATE 1 ° 8/111/2111201155 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 Ileu of such endorsement(s). PRODUCER CONTAME:CT Lori B. Gleason NA Collinsworth,Alter,Lambert,LLC PHONE 561 776-9001 FAX (561)427-6730 23 Eganfuskes Street A/c No Ext):( ) ac,No Suite 102 ADDRESS: Jupiter,FL 33477 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Travelers Indemnity Co.of America 25666 INSURED INSURER B:Phoenix Insurance Co 25623 Pro Sound,Inc.dba Pro Sound&Video INSURER C:Travelers Property S Casualty Co.of America 25674 1375 NE 123rd Street INSURER D: Miami,FL 33161 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. ILTRR TYPE OF INSURANCE INSD WVD POLICY NUMBER MOM /uDD EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR ZLPIOT546881413 07/31/2015 07/31/2016 PREMISES Ea occurrence $ 300,000 X XCU&Contractual MED EXP(Any one person) $ 10,000 X Broad Form Prop Dam. PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT FILOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaeddent $ 1,000,000 B X ANY AUTO BA1A87012714TEC 07/31/2015 07/31/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ XX NON-OWNED PeOecdd DAMAGE $ HIREDAUTOS AUTOS PIP Coverage $ 10,00 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE ZLPIOT546881413 07/31/2015 07/3112016 AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION X PER O - AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN HDTCNUB752ON42214 07/31/2015 07131/2016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA (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 A Rented/Leased Equip. ZLP10TS46881413 07/31/2015 07/31/2016 Limit Per Item 30,000 A Rented/Leased Equip. LP10TS46881413 07/31/2015 07/31/2016 Total Policy Limit 75,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N more space Is required) RE: Contractor License Number ES0000149; Project- Barry University The Certificate Holder is listed as an Additional Insured for General Liability,including products&completed operations,perform 47150,Automobile,and Umbrella coverages when required by written contract.The General Liability,Auto,and Umbrella coverages are primary&noncontributory when required by written contract Waiver of Subrogation applies with respect to General Liability,Automobile,Umbrella,and Workers'Compensation coverages when required by written contract Should any of the above described policies be cancelled,notice will be delivered in accordance with the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Bldg Dept ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD