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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