DEMO-10-1683BUILDING
PERMIT APPLICATION
FBC 20
City: Miami Shores
Folio/Parcel #:
Is the Building Historically Designated: Yes
Type of Work: CI Address DAlteration
Description of Work: N
Submittal Fee $ Permit Fee $ /6 ®E' ®"
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
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 rr ,,
OWNER: Name (Fee Simple Titlehold F cw.1r IO�t iQ Phone #: &AC' 59 9 -3 / 1 -C
Address:// gvb Are 'ow e-
City: / J6'•1' State: rt Zip: 'NO
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: 1 I 30C) nC 2" new 144
County: Miami Dade
NO ✓
CCF $
331(01
Flood Zone:
CONTRACTOR: Company Name: St V12Y 1IPC1iiCG 1 Corgva Phone #: . 712 - 21`7'375 N
Ad ss: u?_ci 1 1�1 ►1 Q OW
City: Q I hi
Ci � � } N State: f I Zip: i W 0
p:
Qualifier Name: john W e�, l Phone#: n �
State Certification or Registration #: EC 1, 5 Certificate o Competency #:
Contact Phone #: •7 7Z_ 21P - 'C E mail Address: __ (Q S�Y�,Ih�'.e IBC +r (c • COm
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 4)00 Square/Linear Footage of Work: 3 WO (4 Prole
ONew DRepair/Replace trDemolition
******** * * ** * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees** * *m:a**m**** ****** * * ****** ** * * * ** x ****x ***
CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $
10 (� b
4 � SEP 2 1 2iM
BYE.......................
Permit No. t akJ1P*4
Master Permit No. QC 10— 1 l ��
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 FT .RCTRICAL 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 seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will no be approve cjiR y a reinspection fee will be charged
Signature
APPROVED BY
'&caner or Agent
The foregoing instrument was acknowledged before me this
day ofK:t_20 el, by � 9i' /
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
472‘ :. L ?2
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Signature
Contractor
The foregoing ins a usent was acknowledged before me this 1
onally known to
day of , 20 by
by
who is
e
NOTARY plful rC4TA ssion
My Commission Expires: 6A My
a� ', .J �speil �� miller ��
I ,; ') Commission #DD6d1298
',,',,` , : :I '' Expires: AP. 10, 2011
+ i��N* �k�k�h+ p�H�kgsge�e�r�k�k�R�kspNsskB +%+*AR **ih*Xs*******ik***** k***n+***+k***
or who has produced
as identification and who did take an oath.
Ul1�E T
LISA CUNI
T* MY COMMISSION 8 DD 987814
V . Y- et EXPIRES: June 18, 2014
T,. ' Bonded Thru Notary taty PubBc Underwriters
PPS® Plans Examiner Zoning
Structural Review Clerk
I
b
Inspection Number: INSP - 151518
Scheduled Inspection Date: September 28, 2010
Inspector: Bruhn. Norman
Owner: , BARRY UNIVERSITY
Job Address: 11300 NE 2 Avenue Garner Building
Project: <NONE>
Contractor: STRYKER ELECTRICAL CONTRACTOR INC
Building Department Comments
ELETRICAL DEMOLITION OF BREEZEWAY
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
September 27, 2010
Miami Shores, FL 33138 -0000
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Permit Number: DEMO -9 -10 -1683
Permit Type: Demolition
Inspection Type: Final
Work Classification: Electric
Phone Number
Parcel Number 1121360010160 -22
Page 16 of 22
THIS 1S 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 CONDI7ON 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.
I
LTR
LTR
TYPE OF INSURANCE
u
DISK
SU Iih
WVD
POLICY NUMBER
( MdUI�
(MOOOP;
LIMITS
INSURER(S) AFFORDING COVERAGE
GENERAL
LIABILITY
COMMERCIAL GENERAL
LIABILITY
OCCUR
10385
INSURER B :
INSURER C:
EACH OCCURRENCE
$
—
P REMIS ES (Ea occurrence)
$
CLAIMS -MADE
MED EXP (Any one person)
$
PERSONAL & ADV INJURY
$
GEdERALAGGREGATE
$
GEWL AGGREGATE UNIT APPLES PER:
—I POLICY TI JEC I we
PRODUCTS- COMP/OP AGO
$
$
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
COMBINED SINGLE LIMIT
(Ea accident)
$
—
—
—
_
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY AGE
$
$
$
UMBRELLA LIAB
EXCESS LIAR
—
OCCUR
CLAIMS -MADE
EACH ODCURRENCE
$
AGGREGATE
$
—
DEDUCTIBLE
RETENTION $
$
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUT
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH)
if yes, describe under
DESCRIPTION OF OPERATIONS
Y / N
N/A
WC 84000183722 10A
01 /01 /10
01/01/11
X ITO�u ITS I E
E,L. EACH ACCIDENT
$500,000
$500,000
u
below
E.L. DISEASE - EA EMPLOYEE
EL DISEASE - POLICY LIMIT
$ 500,000
DESCRIPTION OF OPERATION, / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace is required)
•
Ad - C: ■ RH CERTIFICATE OF LIABILITY INSURANCE OP ID T4
� '
DATE(MM/DD/YYYY)
09/21/10
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 poltcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. Astatement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
Brown & Brown of Florida, Inc.
5900 N. Andrews Ave. #300
P.O. Box 5727
Ft. Lauderdale TL 33310 -5727
Phone:954- 776 -2222 Fax:954 -776 -4446
wnlAul
PHON FAX
NO,Ext): �(AIC,No):
ADDRESS:
PRODUCER I OOMEFlP3 E: STRYX - 4
INSURER(S) AFFORDING COVERAGE
NAACP
INSURED
Stryker Electrical Contracting
Inc.
Attn: Scott Eccleston
424411 SW i c h Meadow Avenue
Palm
INSURER A: TVA Mutual Insurance Co.
10385
INSURER B :
INSURER C:
INSURER D :
INSURER E :
INSURER F :
COVERAGES
CERTIFICATE HOLDER
CERTIFICATE NUMBER:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores Village
Attn: Building Dept.
10050 NE 2nd Avenue
Miami Shores FL 33138
MIAMISH
ACORD 25 (2009/09)
CANCELLATION
AUTHORIZED REPRESENTATP/E
The ACORD name and logo are registered marks of ACORD
REVISION NUMBER:
PORATION. All rights reserved.
VGf,, .li-1V,,....,V..va.,. -
-- --- - -- -- - - -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF; NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH 'THE POLICY PROVISIONS.
AUTHORIZE R
RESENTATIVE
® CERTIFICATE OF LIABILITY INSURANCE D�zi Q Y)
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 DR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER Sue Roaf
Collinsworth, Alter, Lambert, Inc IA= N t '.xt$ (561)776-9001
FAX
Collinsworth, t561)427 -6730
23 Eganluskee Street £6calino.
Suite 102
Jupiter Fri, 33477 INSURERS) AFFORDING COVERAGE NAIO d
INSURED INSURER A :Natiotlai. Trust Insurance Co
INSURER B :FCC/ Insurance Company
Stryker Electrical Contracting, Inc. INSURER C:
4241 Southwest High Meadow Ave INSURER D:
INSURER E:
Papa City FL 34990 INSURER F:
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.
Mil TYPE OFINSURANCE 1U15R11NVD
POLICY NUMBER ( DDDIYY tM DDtt WY)
LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
Tel COMMERCIAL GENERAL LIABIITY PREMISES IEa occur:e:uel $ 100 , 0 00
A CLAIMS-MADE X O C C U R GL00103ED 6/1/2010 6/1/2011 MED EXP (Airy Ana pees ) t 5,000
X ss' Prop Dam , xcv PERSONAL s ADV INJURY $ 1, 000,000
X Contractual GENERAL AGGREGATE 5 2,000,000
GENLA GRE PER PRODUCTS-COMP/OPAGO $ 2,000,000
I - 1 POUCY [TIC I jig LOC $
AUTOMOBILEIJABIUTY COMBINED SINGLE UMtr $ 1,000,000
(Es scr1de t1
X ANY AUTO BODILY INJURY (Per pemat) 5
A ' ALL :ADO16058 6 /1/2010 6/1/2011
BODILY INJURY (Per aeddsnt} 5
SCHEDULED AUTOS PROPERTY DAMAGE
X HIRED AUf43
(Per I) $
X NON-OWNED AUTOS Medal payments S 5,000
PIP -Basic 4 10 , 000
X UMBREJ.AUAB OCCUR EACH OCCURRENCE S 4,000,000
^
IBICESSLIAB CLAIMS -MADE AGGREGATE $ 4,000,000
DEDUCTIBLE $
A X RETENTION 5 10,000 .0A030010748 6/1/2010 0/1/2011 $
WORKERS COMPENSATION IMPAil VW-
AND EMPLOYERS' LIABILITY
ANY PROPMETOWPARTNERIEXECUTIVE Y NIA EL EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
yes, a In u H) EL DISEASE - EA EMPLOYEE 5
DESCRIPTION OF OPERATIONS beiow E.L. DISEASE - POLICY UMW S
B Owned Equipment and 410005439 5/1/2010 6/1/2011 As scheduled Deductible
Rented or teased 5301000 $2,000
DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD 10I, Additional RemadiS Schedule. iI mare space is required)
COVERAGES
ACORD 26 (2009109)
INS026 paws)
CERTIFICATENUMBER:10 /1.1. New Fret CGL084 /025
REVISION NUMBER:
v racv - wa rwv.w v....r v.v+..0 ..... ...�....
The ACORD name and logo are registered marks of ACORD
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.
Mil TYPE OFINSURANCE 1U15R11NVD
POLICY NUMBER ( DDDIYY tM DDtt WY)
LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
Tel COMMERCIAL GENERAL LIABIITY PREMISES IEa occur:e:uel $ 100 , 0 00
A CLAIMS-MADE X O C C U R GL00103ED 6/1/2010 6/1/2011 MED EXP (Airy Ana pees ) t 5,000
X ss' Prop Dam , xcv PERSONAL s ADV INJURY $ 1, 000,000
X Contractual GENERAL AGGREGATE 5 2,000,000
GENLA GRE PER PRODUCTS-COMP/OPAGO $ 2,000,000
I - 1 POUCY [TIC I jig LOC $
AUTOMOBILEIJABIUTY COMBINED SINGLE UMtr $ 1,000,000
(Es scr1de t1
X ANY AUTO BODILY INJURY (Per pemat) 5
A ' ALL :ADO16058 6 /1/2010 6/1/2011
BODILY INJURY (Per aeddsnt} 5
SCHEDULED AUTOS PROPERTY DAMAGE
X HIRED AUf43
(Per I) $
X NON-OWNED AUTOS Medal payments S 5,000
PIP -Basic 4 10 , 000
X UMBREJ.AUAB OCCUR EACH OCCURRENCE S 4,000,000
^
IBICESSLIAB CLAIMS -MADE AGGREGATE $ 4,000,000
DEDUCTIBLE $
A X RETENTION 5 10,000 .0A030010748 6/1/2010 0/1/2011 $
WORKERS COMPENSATION IMPAil VW-
AND EMPLOYERS' LIABILITY
ANY PROPMETOWPARTNERIEXECUTIVE Y NIA EL EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED?
yes, a In u H) EL DISEASE - EA EMPLOYEE 5
DESCRIPTION OF OPERATIONS beiow E.L. DISEASE - POLICY UMW S
B Owned Equipment and 410005439 5/1/2010 6/1/2011 As scheduled Deductible
Rented or teased 5301000 $2,000
DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD 10I, Additional RemadiS Schedule. iI mare space is required)
COVERAGES
ACORD 26 (2009109)
INS026 paws)
CERTIFICATENUMBER:10 /1.1. New Fret CGL084 /025
REVISION NUMBER:
v racv - wa rwv.w v....r v.v+..0 ..... ...�....
The ACORD name and logo are registered marks of ACORD
COVERAGES
ACORD 26 (2009109)
INS026 paws)
CERTIFICATENUMBER:10 /1.1. New Fret CGL084 /025
REVISION NUMBER:
v racv - wa rwv.w v....r v.v+..0 ..... ...�....
The ACORD name and logo are registered marks of ACORD