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Permit No. PLC-8-16-2373
�sKO1 s y,� Miami Shores Village • Permit Type:Plumbing-Commercial
10050 N.E.2nd Avenue NE
Work Classification:Addition/Alteration
• �' Miami Shores,FL 33138-0000 Per I
Pennit Status APPROVED
Phone: (305)795-2204
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issue Date: 1012612016 Expiration: 04124/2017
Project Address Parcel Number Applicant
11300 NE 2 Avenue Number: Fine Arts Quad 1121360010160-06 BARRY UNIVERSITY INC
Miami Shores, FL 33138-0000 Block: Lot: I
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: $ 54,000.00
AL HILL ENTERPRISES CORPORATIC (305)687-9963
Total Sq Feet: 0
Type of Work:PLUMBING PART FOR THE WORK IN Available Inspections:
Type of Piping: Inspection Type:
Additional Info:PLUMBING PART FOR THE WORK IN Top Out
Classification:Commercial Re Pipe I
Scanning: 1 Main Drain
Heater
Water Service
Final
Water Main
Lavatory
Review Plumbing
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $32.40
Invoice# PLC-8-16-61093
DBPR Fee $28.35
DCA Fee $28.35 08/24/2016 Check#'001703 $50.00 $ 1,986.10
Education Surcharge $10.80 10/26/2016 Check#: 1818 $ 1,986.10 $0.00
Permit Fee $1,890.00 �.
Scanning Fee $3.00
Technology Fee $43.20
Total $2,036.10
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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 AFFIDAV T: 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 z uthermore,I authorize the above-named contractor to do the work stated.
October 26, 2016
r}Auth zed Signature:Owner / Applicant / Contractor / Agent Date r
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Building Department Copy
October 26, 2016 1
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000647
Local Business Tax"Receipt
Miaml Dade County,:State of Florid
-THIS IS NOTA BILL-DO NOT PAY
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BUMNESS NAME%LOCATION RECEIPT NO: EXPIRES co
AL HIiL ENYERPRlSE CORP RENEWAL SEPTEMBER"30,2017 U,
13740 NW 19 AVE:BAY12 635301 Must be displayed'at place of business 01OPA 1.00KA FL 33054 Pursuant to County Code rn
Chapter A-Art.9 10
OWNER - SEC.TYPE OF BUSINESS PAYMENT RECEIVED
AL HILL:ENTERPRISE CORP 196 PLUMBING CONTRACTOR BY rax COLLECTOR
000016732
Wt rker(s) 10 -845.00 07/19/2016
CREDITCARD-16-042060 0
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This local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, rn
permit or a certification of the holder's qualifications,to do business. Holder must comply with any governmental ry
or nongovemmental regulatory laws and requirements which apply to the business. _o
The RECEIPT N0.above must be displayed on all commercial vehicles-Miami-Dade Coda Sec ga-276. rn
for more information,visit wwwmiamidadamoyRaxcollector
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RICK SCOTT,GOVERNOR ntN LAMUN, -)rL MC I/AM I
STATE OF FLORIDA T,
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION o
CONSTRUCTION INDUSTRY LICENSING BOARD
CFCA58101 "'..�. _
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The PLUMBING CONTRACTOR ~F^
Named below IS CERTIFIED- n
Under the provisions of Chapter 489 FS,
.Expiration date: AUG 31, 2018 `
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-HILL,ALBERT " _ ❑ ZEcn
AL HILL ENTERPRISE TION
x$140 NWA AV .r4
OPA-LOCKA
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ISSUED: 07/31/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1607310003026 oW
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From:AL HILL PLUMBING CORP 305 681 5566 10/26/2016 14:52 #421 P.001 /005
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY)
`"'� 1 10/13/2016
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(ies) must be endorsed. If SUBROGATION IS WANED,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 CONT
g Campbell
Lei hton C
1st Allegiant Insurance, LLC PHONE (954)378-3235 FAX (954)323-5477
No:
2419 Hollywood Blvd, ADDREs :leighton@lstallegiant.com
Ste. E INSURER(S)AFFORDING COVERAGE MAIC r<
Hollywood FL 33020 INSURER Evanston 35378
INSURED
INSURERBOhio Security Insurance Co 24082
Al Hill Plumbing Corp. Al Hill Enterprise Corp. INSURERC:Scottadale Insurance Co
13740 NIN 19th Ave Bay #12 INSURER D:
INSURER E:
Ms ami _ FL 33054 INSURER F:
COVERAGES CERTIFICATE NUMBER:1 Basic Certificate 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.
ILTR NER TYPE OF INSURANCE DL POLICY EFF POLICY EXP
POLICY NUMBER MIDDrYYYYI LIMITS
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
A CLAIMS-MADE Fx_1 OCCUR _E!RE15AMAGE TO MRF_Ne occurren $ 100,000
CPS2293732 10/22/2016 10%22/2017 MED EXP(Any one arson) $ 5,000
PERSONAL&AOV INJURY $ 1,000,000
GEN POLICY GATE LIMIT APPLIES PER; GENERAL AGGREGATE $ 2,000,000
X POLICY❑SECT LOC '
PRODUCTS-COMA/OP AGG $ 2,000,000
OTHER: Employee Benefits $
AUTOMOBILE LIABILITY COMBINED G LIMIT
I n $ 11000,000
B X ANY AUTO BODILY INJURY(Per person) $
AUTOS
AUTOS 811956957348 er
AOSCHEDULED 10/22/2016 10/22/2017 BODILY INJURY(Paxident) $
U
X HIRED AUTOS X NON-OWNED
AUTOS PROPERTY DAMAGE $
X UMBRELLA UABPIP-BaaiC $ 10,000
OCCUR EACH OCCURRENCE $ 5,000,000
C EXCESS UAB CLAIMS-MADE
AGGREGATE $ 5 000 OOD
DED RETENTION ZZXS1002204 10/22/201610/22/2017 $
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY PER OTH-
Y/N ER
ANY PROPRIETOR/PARTNER/EXECUTNE
OFFICER/MEMBER EXCLUDED? E-1 N/A E.L.EACH ACCIDENT $
(Mandatory In NH)
H yes,describe under E.L.DISEASE-EA EMPLOYEM$
DESCRIPTION OF OPERATIONS below
E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
LICENSE: CFCA58101
CERTIFICATE HOLDER CANCELLATION
( )
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
10050 PIE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores, FL 33138
AUTHORIZED REPRESENTATIVE
Leighton Campbell/LC '. rG
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025onuml
From:AL HILL PLUMBING CORP 305 681 5566 10/26/2016 14:54 #421 P.003/005
t
CERTIFICATE OF LIABILITY INSURANCE1/
29/2016
?-HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERSNO RIGHTS UPON THE C:ERT'IFiCATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR A,..TER THE COVERAGE AFFORDED 8Y THF POLICIFS
,.,Ow 'HIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Si, AUTHORIZED
yRES£NTATIVF. OR PRODUCER. AND `HF. CERTIFICATE HOLDER.
~IMPORTANT: I(the cerlifi;mcf holder Is an ADD1110NAL INSURED, the policylE¢s) !nus! bo endcrseli, t' SU8ROGAVON IS WAIVED, subject to
the terns and conditions n'tic policy.certain porucios may require 4m endorsement. A slatcn{c•tt on ct:'rtl(icale ti:;es not canter riqn' s to!ho
:;erttticate A,n;der in Gcu of such endorscment!s!.
BENDELL INSURANCE GROUP INC " ' At'�'PREW OGHINAN
ESO Box 1E4235t305)249.•„>.`57
'`'L 33116-4235
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AL HILI. PLUMBING CORPORATION
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AL HILL ENTERPRISE CORPORA'I'IO*J
13740 NW 19TH AVE BAY#12
OPA LOCKA, FL 33054
_ 305-687-9963
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WAIVER OF SUBROGATION AS R..ESd'k::C'I' ^p WORKER'S 001—VENSA_`ION APPT.,IES: FOR ALT AS PEk
WRIt'.'EN CQNT1kACT.
MI7-QMT SHORES VILLAGE
E3l,._..UI'_'7G llEl�'Al?' 'tom ,i i }Er t f �I' 156,:!. f f r�f { .0%E`c N! r'..E+ Ft ,.•it
10050 NE 2ND AVENUE
j MIAMI SHORES, FI,OR.IDA 33138
.! A(.:J!'.£)COJ?VOIRA';ION rlcNtS'.5<-.ry '
Miami Shores Village RECEIVED
g q 4 2016
Building Department BY: u
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 20
BUILDING Master Permit No. CC-1a-15"303
PERMIT APPLICATION sub Permit No. ()LC 1(3-23-B
❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
iPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 1130-0 N t✓ Q A-vent'� '. ri ne. 4,r-k., D-VCz Lan-�
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: ( (R1 3100 y ( y l (n o —(O o Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name(Fee Simple Titleholder): Phone#: ,._.
Address: Ik5D(7 INS o? �a 'kvenw¢,
City: VA;oay); J q,,f 2-S State: (-Q Zip: (e) —
Tenant/Lessee Name: w Phone#:
Email:
CONTRACTOR:Company Name: 1--t� 1' CACI O�►S2. �� . Phone#: -3o5-00`77 (03,
Address: V-51 4D N ! {
City: lLa
L State: 6"-A -C Zip: 3-�> 05 T
Qualifier Name: � •'"`� ` Phone#: 301— 770-3P32
State Certification or Registration M CFC A 578"10 I nn Certificate of Competency#: t
DESIGNER:Architect/Engineer: ROLY U Q(� ,D 1 4 i-tYe.�1� �2y rpe- PPho/ne#: 5(o1 q7 i�—V(f57
Address:,04-1 \,. `�T� Yriu!k iJJC��{ `�-Vt . )0 City: W-Q-� PGI#)gaState: Zip:33q l
Value of Work for this Permit:$ 54+1 0 d d` 07 Square/Linear Footage of Work: CD
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: C-e-VL &V'& n.
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Specify color of color thru tile:
Submittal Fee$ 5 Permit Fee$ CCF CO/CC$
Scanning Fee$ Radon Fee$ . 3 5 DBPR$ Z O • 3 S Notary$
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Technology Fee$ u J Training/Education Fee$ ��Y� Double Fee$ 1•�J
Structural Reviews$ Bond$ 4er
elL, TOTAL FEE NOW DUE$ I -` ?67
(Rev1sed02/24/2014) G
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Bonding Company's Name(if applicable)
i
Bonding Company's Address -
+ i
City State Zip i
Mortgage Lender's Name(if applicable)
i
Mortgage Lender's Address
City State Zip +
Application is her made to.obtain a permit to do the work and installations as indicated. I certify that no workor 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.
> i
"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
i
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 pasted notice, the
inspection will not be approved and a reinspection fee will be charged.
SignaturetQQJA Signature-k5PWFF%—�Azz
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OWNER or AGENT CONTRACTOR
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The foregoing instrument was acknowledged before me this The foregoing instr en wad acknowledged before me this
�►�, day of OCfii()�5'2- 20 �D by day of. /N�� �� f by
'&UI AN N' A1' who is personally known to 1 a' +iw o is personally known
me or who has produced as me or who has produced as
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identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTAR
Sign: Sign:
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Print: !J
V Print: t,rnct•r- c ( �.`> �
°``� P;3�� VERNARDA TEAL
Seal. ,.�► Notary Puafe State of Florida Seal: * * MV COMMISSION#FF 146575
r Jeffry J Y80
My Cprtrmisafor►FF 188481 m� P EXPIRES:July 30,2018
+ « Expina 1 111 2/2 01 8 '7`OF IOOO Bonded Thru Budget Notary Services
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APPROVED.BY / (� Plans Examiner Zoning
Structural Review Clerk
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(Revised02/24/2014)
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