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CC-10-1585V io 110-A4ecif ct 1231 - hA - i<vi" BUILDING PERMIT APPLICATION FBC 20 Permit Type: BUILDING OWNER: Name (Fee Simple Titleholder): OL;Ilt■ft Address: MOO City: M''CGttw 5144 re4 State: Tenant/Lessee Name: Email: JOB ADDRESS: 113 NC o � kt /V€. City: Miami Shores Is the Building Historically Designated: Yes tAikko. 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 County: Permit No. Master Permit No. Miami Dade CONTRACTOR: Company Name: 6(24 foit (Z 9 Address: /T A 7 eSa 1.-^114 �� Q e -` - r'^ City: Rte' 1 e- . l. State: F 1 Qualifier Name: fir t P er fi State Certification or Registration #: Contact Phone #: qq Email Addr ss: DESIGNER: Architect/Engineer: he, h 1 ►�� Q k'Vc I hone #: Value of Work for this Permit: $ 0 OO Square/Linear Footage of Work: Type of Work: ❑Address DAlteration / New DRepair/Re ace Description of Work: t7� / 0-t - A ® r �-z 6 paMRWRI Ict CEP 0 3 2010 BY: Phone #: da -3 Pft Phone #: Zip: Phone #: Zip: 3Q-- Zip: Folio/Parcel #: NO Flood Zone: Phone #: P -1 7 Certificate of Competency #: 'fit -44776 LMDemolition COLOR THROUGH ROOF TILE IS REQUIRED acknowledged by: * ** ** * * *** *, * ***** , , , ** * * * ****** *, Fees, *** *, *, **** **** **** * * * ** * *** * * * *** ** * *** Submittal Fee $ Permit Fee $ jO ex) CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 3 (• 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs even (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved 4 , reinspection fee will be charged. Signature r NOTARY PUBLIC: Sign: Print: My Commission Expires: 1 APPROVED BY (Revised 07 /10 /07XRevised 06 /10 /2009XRevised 3/15/09Xrev6/4/10) Signatur Owner or Agent The foregoing g g instrument was acknowledged g before me this 36 The foregoing instl�ultlent was acknowledged before me this 30� day of ktu �° , 20111, by O e)Vi S , day of 20 /f", by 4 f 1/041 , who is personally known to me or who has produced who is personally known to me or who has produced as identification and who did take an oath. As identification and who did take an oath. Er A �. e u•Ic Je J Yao o 4 My Commission DD613542 Expires 11112/2010 eo o i ii 0 I ' , Contractor Sign: Print: My Commission Expires: Kilululk Y • 'i4 11; _ ! �+ Il A 1 �i .: �' � 1 l r 1 '� , y : arry Imon ;Commission #DD665910 * *, * * *, *, *** *** ** *** * ** * **** * *****************************************************% ,r**** *, * *** * *,r ** *********** *% x .` E, g *ATN$liA 2011 BONDED THRII ATLANTIC BONDING CO., INC. 07�6/a Plans Examiner Zoning Structural Review Clerk Inspection Number: INSP- 150802 Scheduled Inspection Date: September 29, 2010 Inspector: Bruhn, Norman Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Garner Building Project: <NONE> Miami Shores, FL 33138 -0000 Contractor: BELFOR USA GROUP INC Building Department Comments REMOVE FIRST FLOOR BREEZEWAY CEILING Pass 2gyfd Failed Correction Needed Re- Inspection Fee September 28, 2010 No Additional Inspections can be scheduled until re- inspection fee is paid. Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspector Comments rc, For Inspections please call: (305)762 -4949 Permit Number: CC -9 -10 -1585 Permit Type: Commercial Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1121360010160 -22 Phone: (954)275 -1977 Page 5 of 17 Permit # Folio # 4. a. Contractor name and address: b. Contractor's phone number. 5. a. Surety name and address: b. Surety's phone number c. Amount of bond: 6. a. Lender name and address: b. Lender's phone number. Name: Address: b. Phone number. NOTICE OF COMMENCEMENT The undersigned hereby gives notice that improvement will be made to certain real property and In accordance with Chapter 713, Florida Statutes, the following information is provided In this Notice of Commencement : 1. Legal Description of Property: Lot Block Sybally(slon / Condpniipiu r : Street Address if available: f'I J ©C /V= 2. General description of Improvement : e-PV t21% t ( ' a.edit'$Y - r yL < .Q 3. a. Owner name and address: " �J ► 4 ;to `" i uhf /' ✓ y 6 p/ kakAye . � ' - / /, r b. Interest in property: (25. 9 33461 c , Name and address of fee simple titleholder (If other than Owner): 7 Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes: 8. a. In addition to himself or herself, the Owner designates b. Phone number of person or entity designated by owner 9. Expiration data of notice of commencement : 'ID f, 43 't to receive a copy of Lienor's Notice per Section 713.13(1)(b), Florida (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECe.►1D''NG YOUR NOTICE OF COMMENCEMENT. natu Si re s of Owner(s) �" rized By (� er(s)or o y,a Print Name 4 y . S Title/Office j1¢ d ' / i G+" STATE OF FLORIDA COUNTY OF BROWARD , 1 A The fomgoingi was�� ovfle�g Ik efore me this day of V► �� c. I. .�0IndNfotually, or 0 as 4l for IXI Personally known, or ❑ produced thefoltcabhrg type of identification: VERIFICATION PURSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury,1 declare that I have read the foregoing and that the facts stated In it are true,the•best of my knowledge and belief. Signature(s) of Owner(s) By X Officer/Director/Partner/Manager By Print Name Tits/Office Signature of Notary Public: Print Name: (SEAL) orized Officer/Director/Parti er/Manager who signed above: this space reserved for recorder Unit # Bldg # ElLengthy legal attached By g vVamslrmc. notice of mrmmencement revised 7.3.07.dr 11111111111111111 11111 11111 1111111111 1111 1111 CFI4 201.0R0589514 OR Eik 27404 Ps 4446; (1ps) RECORDED 08/31/20110 12:19:32 HARVEY RUVIHp CLERK. OF COURT MIAMI —CE E COUNTY' FLORID LAST PAGE 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. LIMITS SHOWN ARE AS REQUESTED INSR LTR ADD'L ?NM TYPE OF INSURANCE POLICY NUMBER GL4376513 POLICY EFFECTIVE DA's 04/01/2010 - POLICY EXPIRATION DATE(AIMUDD/YYYY) 04/01/2011 LIMITS EACH OCCURRENCE 51,000,000 B X immo — GENL ❑ COMMERCIAL GENERAL LIABILITY CLAIMS MADE hi OCCUR DAMAGE TO RENTED PREMISES occurrence) 51,000,000 MED EXP ( one person) 5100, 000 PERSONAL & ADV INJURY 51,000,000 GENERAL AGGREGATE 52,000,000 AGGREGATE LIMIT APPLES PER: PRODUCTS - COMP /OP AGO 52,000,000 ��� PRO- X LOC JECT A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS comp led 51,000 CA 8263538 04/01/2010 04/01 /2011 COMBINED SINfavIIMIT (Ea accident) $1,000,000 X X BODILY INJURY ( Per person) ■ X BODILY INJURY (Per accident) ■ X PROPERTY DAMAGE accident) © (Per collision oed 51.000 GARAGE e LIAB TTY AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGO $5,000,000 A EXCESS X ■ © /UMBRELLA LIABILITY OCCUR ❑ CLAIMS MADE DEDUCTIBLE RETENTION 510,000 8E9613260 04/01/2010 04/01/2011 EACH OCCURRENCE AGGREGATE $5,000,000 8 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER /EXECUTIVE N OFPXCE.R/MENIBER EXCLUDED? (Mandatory in NR) wc020634971 04/01/2010 U4 /01/GUll x IIVC STATU -I IOTH ITORY LIMITS ER E.L. EACH ACCIDENT 51,000,000 000, 000 E.L. DISEASE -EA EMPLOYEE 51, 000 ,000 If yes, describe under SPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT 51, 000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Project Name: Barry University. 9/1/2010 3 :47:20 PM COVERAGES CERTIFICATE HOLDER Miami Shores village Bldg., Dept. 10050 NE 2nd Ave. Miami Shores FL 33138 USA ACORD 25 (2009/01) Faxserver CANCELLATION AUTHORIZED REPRESENTATIVE 847 - 953 -5390 SIR applies er terms Page 3 CERTIFICATE OF LIABILITY INSURANCE PRODUCER Aon Risk Services central, Inc. Southfield MI Office 3000 Town Center Suite 3000 Southfield MI 48075 USA PHONE - (866) 283 -7122 FAX - (847) 953 -5390 INSURED Belfor USA Group, Inc. 1520 S. Powerline Road suite A Deerfield Beach FL 33442 USA DATE(MM /DD /YYYY) 08/30/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INsuRERA: Insurance company of the state of PA INSURERB: National Union Fire Ins co of Pittsburgh mamERe Chartis specialty in surance Company INSURER D: INSURER E: NAIC # 19429 19445 26883 ry and conditions of the policy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OP ANY RIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. . Jie ecerO AEG �vaa ©1988-2009 ACORD CORPORATION. M1 rights reserved The ACORD name and logo are registered marks of ACORD