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ELC-10-1936Inspection Number: INSP - 152860 Scheduled Inspection Date: December 16, 2010 Inspector: Devaney, Michael Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Adrian Hall Miami Shores, FL 33138 -0000 Project: BARRY UNIVERSITY Contractor: TRI -CITY ELECTRIC CO INC Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 REPLACE UPS FOR DATA CTR. Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments December 15, 2010 For Inspections please call: (305)762 -4949 Permit Number: ELC -11 -10 -1936 Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360010160 -07 Phone: (305)642 -5428 Page 11 of 22 BUILDING PERMIT APPLICATION FBC 20 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 Type: Electrical OWNER: Name (Fee Simple Titleholder): Q'�}P/1 44'10 -1 � Phone#: 30 - 8 'i Address: U SD WE D a 1 Ave City: PI, S Of*" State: 1:1. Zip: 33 16n Tenant/Lessee Name: Phone#: Email: .g.ltiA< < _ tNA(('( . k JOB ADDRESS: 11 1a Mt, — -D „I ANA City: Miami Shores County: Miami Dade Folio/Parcel#: - r J 3 ‘) - 0 O b - Is the Building Historically Designated: Yes NO CONTRACTOR: Company Name: i -C4- I ae-Cfri e.- Co'i e• Address: ( Es KUL) 1(P kit, Cit IA a.mi State: FL NOV 0 2 2010 Permit No. "'"' 0- 1q3(9 Master Permit No. 4-' C\L Flood Zone: Zip: 331(e Phone #:35-le-i g SUS (,Lt2 — 15 22. Zip: 331 Qualifier Name: s) . . Phone#: State Certification or Registration #: (CCX CO 1 Certificate of Competency #: Contact Phone #: 4a�5 Email Address: DESIGNER: Architect/Engineer: Phone#: PP @ a �c Value of Work for this Permit: $ � b • Square/Linear Footage of Work: Type of Work: DAddress ❑Alteratiionn ❑New �o ❑Repair/Replace ❑Demolition Description of Work: 1 CLC ups J -For c,_ x * ** **** **** * * * ** * ** *** *� * ** * **** * ***F *�x� * ** * ******** * * * * *:x�xa�+x,x,x�x� *** **** * * * * ** Submittal Fee $ KJ> Permit Fee $ /lr'1' Ge CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ - L r I, TOTAL FEE NOW DUE $ 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 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 whici occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be a d and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day o ' # 11r , 2011, by NA%) LOWhROS' , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: State of Florida Si 1 t ' ► ' pb613542 OF = ' fires 1/12/2010 • My Commissi * * * * * * * * * * * * * * * * * * * *, APPROVED BY * * * * * ** * ** ** six *** ************* ** ****a *** * * * ** ******* ** ***** ****+x****** ** ****** (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Plans Examiner Structural Review Signature Contracto The foregoing instrument was acknowledged before me this a 1141---/ day of Altr- he , 20l U , by l) e td t',6 Tr - who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Zoning Clerk 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS A GENERALLU►BILITY COMMERCIAL GENERAL LIABILITY CO3664P993TIA10 07/01/2010 07/01/2011 EACH OCCURRENCE $ 1,000,000 X PREMISES(Ea o�nce) $ 300,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 X Blkt Contractual PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY X ECT LOC PRODUCTS - COMP /OP AGG $ 2,000,000 B AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS FOR HIRED AUTOS NON -OWNED AUTOS 8103664P993C0F10 )1,000 DED COMP /COLL - PPT AND LIGHT TRUCKS $2,000 DED COMP /COLL FOR MEDIUM VEHICLES 07/01/2010 07/01/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE UABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ C EXCESS X / UMBRELLA UABIUTY OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ 10,000 CUP3664P993TIL10 07/01/2010 07/01/2011 EACHOCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ X $ $ D WORKERS AND EMPLOYERS' ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER (Mandatory If SPECIAL P RO SPECIAL PROVISIONS COMPENSATION UABIUTY / N EXCLUDED? L J 083045364 07/01/2010 07/01/2011 �J W X WC LIMIT ° TORY LIMITS I ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 in NH) ISIOr below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS *Except 10 days notice of cancellation for non - payment of premium. Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES DATE THEREOF, THE ISSUING INSURER WILL NOTICE TO THE CERTIFICATE HOLDER NAMED BE CANCELLED BEFORE THE EXPIRATION ENDEAVOR TO MAIL 30* DAYS WRITTEN TO THE LEFT, BUT FAILURE TO DO SO SHALL Building & Zoning Department IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 10050 NW 2nd Avenue REPRESENTATIVES. Miami, FL 33150 AUTHORIZED REPRESENTATIVE ,,, j ' I Alex Perez /REENIE ACORN„ CERTIFICATE OF LIABILITY INSURANCE PRODUCER 305.558.1101 Keen Battle Mead & Company 7850 Northwest 146 Street Suite 200 Miami Lakes, FL 33016 FAX 305.822.4722 INSURED Tri -City Electric Company, Inc 625 NW 16th Avenue Miami, FL 33125 -4611 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT FICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER k. Travelers Indemnity Company INSURER B: Charter Oak Fire Insurance Co INSURER C: Travelers Prop Cas Co of Amer INSURER D: Bridgefield Employers Ins Co INSURER E: DATE (MM/DD/YYYY) 06/30/2010 NAIC # 09490 01205 05590 COVERAGES ACORD 25 (2009/01) CANCELLATION The ACORD name and logo are registered marks of ACORD ©1988 -2009 ACORD CORPORATION. All rights reserved