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MC-10-607Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 159727 Permit Number: MC -4 -10 -607 Scheduled Inspection Date: May 16, 2011 Inspector: Perez, JanPierre Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Dalton Hall Miami Shores, FL 33138 -0000 Project: BARRY UNIVERSITY Contractor: HILL YORK SERVICE CORP Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360010160 -17 Phone: (305)756 -6501 Building Department Comments REPLACE AHU IN DALTON/ DUNGPAUGH HALL Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 140365. need to seal holes in slab to shelf jpp May 13, 2011 For Inspections please call: (305)762 -4949 Page 16 of 25 „7- Contract Tide: ,�a►•W nZ�a�q Garry University Division of Legal Affairs LaVoie 209 (309) 899.4784 a MAY 2 6 2010 711E; P.PB.GDPNFRAXdi AAAAdd“ v'a e� .k Contract ttoutine,Lo8 } • _ � ti_tl' Department; Maintenance.. Contact; Lin a Mitts Date; 3/18/2;010 Eat, 3197 Contract Read and Approved by Department. Department Can Comply with terms,, .R Revisions are needed. ,.:...• Signature~ nda itts.: '” . 414 kAt u 4rw ., Print Name:. Linda Mitts: . Date: 3/18/2010 c�- Department Summary: replace the AHU at Dalton; and Pupapa gh with 3 AT U's. Replace.a Its I. fh I t V. t. ttt! act Approved. by Du Budget Signature; Date: Amount: A47,879.06. Contract Reviewed by Legal Contains revisions .r,- 1.44(''',''' a.4rra' /441 Nro i ` sions Depattnricnt *A_.1 R:'_.Y= 1.1. 10- 13303 - 000001 10- 13309-000001 10- 13316- 000001 CIP Library 159,442'.34 CIP Thompson 155,761.39 CIP DID 132,675.27 Total $447,879.00 (. )kfi (,e ...(//UL-t / IPA (JA'l r,(..A * ** *Please be sure a fully executed original goes to Lena Mercea * * ** CITY OF MIAMI - BUILDING DEPARTMENT NOTICE OF COMMENCEMENT Please file at 22 N.W. ler t, PERMIT NUMBER / O W1 FOLIO NUMBER: State of Florida County of Miami-Dade 111111111111111111111111111111111111111111111 CFN 2010R0395606 OR Bk 27317 Ps 0309; (1ps) RECORDED 06/11/2010 12:5037 HARVEY RUVIHr CLERK OF COURT MIAMI-DADE COUNTY., FLORIDA LAST PAGE STATE OF FLORIDA, COUNTY OF DADE I HEREBY CER /FY that this is le copy of the aiginal Nod i ice on / day of A D 20 lie) d and Official SeaL CLER WITNESS my ha HARVEY RU'JI By The undersigned hereby gives notice that improvements will made to certain real props ac Chapter 713.23, Florida Statutes, the following in provided in this Notice of Commencement. Street address I/300 IVE. a rid Alt, and Legal description of property Description of improvement: kleflitildTWAIMIL61110111M170171,11.110.1M11911111Mil Owner(s) name Barn/ 10i/twilit,' and address: nail) M E. c2nd a qN Interest in property: Name of fee simple titleholder (if other than owner): and address Contractor's n .1 Da . and a &KV/ Phone number: $:_ttfigitlAritint Amount of Surety bond: $ : (Payment bond required by owner from contractor, if any) Surety Name and address Phone number: Lender's name and address Phone number: Persons within the state of Florida designated by Owner, upon whom notices or other documents may be served as provided by Section 713.130)(07, Florida Statues, Name and address: and address In addition to hirearaf, Owner designates the following person(s) to receive a copy of a Lienor's Notice as provided in Section 713.13(1Xb), Florida Statues, Name and address Phone number: Expiration date year from the ;au. riling unless a different date is s /OF- the expiration date is one [1] dfied) E,446 S Day of (-1141.—Islut=2EtibIL Stotu uf Rada' Personally Encwise'l `441,1 .O.Vge 4 .7- My Commission 00613542 Expires 1111212010 Oath taken Oath not taken Commission Expiration: it / t2/ Rev: 512004 ‘or as) odg Prepared by: Vi-'pie apAraf? Address: /01-5 $ • 40c/.46.41,5 JW F/. lIz fi 7) 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 No.J� Master Permit No. BUILDING PERMIT APPLICATION L AP 0 2010 FBC 20 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder) )1 Y ( U L tJ -AS1 Phone # Own 's Address U 1 City '" tukt Gj & )VCj State ft �t96 Ne' 2i Zip '3-5( Tenant/Lessee Name Phone # Email Job Address (where the work is being done) 15b 0 ki 2 City Miami Shores Village County FOLIO / PARCEL # t I /2-1 ( DC) bo Miami -Dade Zip 531.C. Is Building Historically Designated YES :Contractor's Company Name �'1,� � t% Contractor's Address L 01S-6 (sJ cA City M (oL State 4V-1 Qualifier Name a 1 Lem/Ls pc 1 A � State Certificate or Registration No.'( AA -o5 j Contact Phone NO Flood Zone Phone # 3K- 13 ( 1 Zip 331(9i( Phone # Certificate of Competency No. l X3-60 0 (2 c E -mail Architect/Engineer's Name (if applicable) ` `- t alI ",.Phone # CLI q '33L6 Value of Work For this Permit $ � 10 00 0 Type of Work: ['Addition ❑Alteration Describe Work: t� Square / Linear Footage Of Work: ['New L Repa & kto r v 14 epl ace) ❑ Demolition a10 &f. ***************************************Fees******* ***** * * * * ** * * * * * * ** * * * * * * ** * * * * * * * ** Submittal Fee $ Permit Fee $ 400 CCF $/Z ° CO /CC $ Notary $ Training/Education Fee $ Z' 00 Scanning $ 1 -®O Radon $ DPBR $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ SIC) L( - CO Technology Fee $ G '0 Bond $ See Reverse side itA l3 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approve+ : : a reinspection fee will be charged. 40. Signature Owner or Agent The foregoing instrument was acknowledged before me this ?C) day of ,Thci rev\ , 20 I D , by , who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Signature t .✓ _ I Co. actor The foregoing instrument was acknowledged before me this eictti day ofAci2C1,, i 20 /(_, by a re6kni Mao , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: APPROVED BY Examiner Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Sign Print: irk My Commission Exp '$ Notary Public - State of Florida • My Comm. Expires Feb 16. 2014 Commission # DO 961990 Bonded Through National Nay Alan. Zoning Clerk checked May. 13. 2010 3:09PM HILL YORK No. 5538 - - ACORE4M CERTIFICATE OF LIABILITY INSURANCE ccrc 1J., 61147 DATE(MIWDDIYYYYI 3/30/2010 PRODUCER Seitlin Tneuranoa 6700 North Andrews Avenue #300 Ft. Lauderdale FL 33309 (954) 938 -0180 THIS CERTIFICATE IS ISSUED AS A MATTER OP ONLY AND CONFERS NO RIGHTS UPON THE HOLDER. THIS CERTIFICATE DOES NOT AMEND, ALTER THE COVERAGE AFFORDED BY THE POLICIES INFORMATION CERTIFICATE EXTEND OR BELOW. NAIC.# INSURERS AFFORDING COVERAGE INSURED Hill York Service Corporation 2125 0 . Andrews Avenue Port Lauderdale FL 33316 INSURER A: PA MANUFACTURERS, ABSOC INS CO 12262 INSURERS: NATIONAL UNION FIRS INS. CO. 19445 INSURER C 301075 33- 95 -25 -8 INSURER 0: _MB 4 1 2011 / / INSURER E: K 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 L.TRINSRp ADM, L TYPE OF INSURANCE POLICY RUMMER POLICY EFFECTIVE DATS(MM10D= POLICY EXPIRATION MUMMY' LIMITS $ 1,000,000 $ 300,000 A • GENERAL LIABILITY 301075 33- 95 -25 -8 4/1/2010 _MB 4 1 2011 / / EACH OCCURRENCE K COMMERCIAL GENERALLIABIUTY PREMISES (Eaxcvrente) PREMISES CLAIMS MADE X OCCUR MED EXP (Any one person) 0 10,000 X Broad Form Prop Dam PERSONAL &ADVINJURY 5 1,000,000 X Contractual Liab /XCU GENERAL AGGREGATE 5 2,002/000 5 2,000 000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGO POLICY X PR'" LOC A AUTOMOBILE LIABILITY ANY AUTO ALL OVYNEDAUTOS SCHEDULED AUTOS HIRED AUTOS NON- OWNEOAUTOS 151000 33.95.25.8 4/1/2010 4/1/2011 COMBINED SINGLE LIMIT (EaeooMenl) 5 1,000,000 X BODILY INJURY (Per person) $ _ _ X X BODILY INJURY (Para:414N; 5 PROPERTY DAMAGE (Perko :Wont) 5 GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT 5 OTHER THAN EAACG 5 — AUTO ONLY: AGO $ H EXCESSIUMBRELLALWMIUYY OCCUR LJ CLAIMS MADE DEDUCTIBLE RETENTION $ ao,000 5E115794a0 201000 33- 95 -25 -8 4/1/2010 4/1/2010 4/1/2011 4/1/2011 EACHOCCURRENCE $ 70,000,000 10,000,900 AGGREGATE — X $ X TAi�YRr IOET�H- $ A WORICERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUT1VE OFFICER/MEMBER EXCLUDED? I!yea.desalbeunder SPECIAL PROVISIONS below EL. EACH ACCIDENT $ 1,000,000 E,L. DISEASE -EA EMPLOYE E 4 1,000,000 E.L DISEASE - POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS! LOCATIONS !VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS *CANCELLATION CLAUSE 30 DAYS NOTICE OF CANCELLATION SKCBPT 10 DAYS NOTICE FOR NON- PAYMENT OF PREMIUM. PROOF OF INBURANCR ONLY, rcbncrrArt Erna r.,•■s CANCELLATION MIAMI BHORN6 VILLAGE BUILDING, DEPT. 10060 NH 2ND AVENt=g Miami Chores FL 33138 AGORA 25 (2001/08) 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 PO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Page 1 of 1 ®ACORD CORPORATION 4988 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: I NS P- 156046 Scheduled Inspection Date: February 16, 2011 Inspector: Devaney, Michael Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Dalton Hall Miami Shores, FL 33138 -0000 Project: BARRY UNIVERSITY Contractor: JAFE CONTRACTING CO Permit Number: ELC -5 -10 -948 Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360010160 -17 Phone: (954)921 -6360 Building Department Comments HOOK UP FOR UNIT INSTALLATION Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 149464. CREATED AS REINSPECTION FOR INSP- 144455. Add lighting to meet minimum standerds. Cover sq, D panel board. Remove abandoned conduit. Bress up low lovtage cables. NO ACCESS /6/14 )// February 15, 2011 For Inspections please call: (305)762 -4949 Page 21 of 21 *Y k3 4\t a yuqm v „• - ryv , e. •}<, . fi0.kvLa:.. . fi < y v rr Y.• .: > ? 3aM`,MX:' L} rWVnday.xc�> :f«Y.Ya}vw..f�v .4rh }a ?J.J «:,.a :t•:::3. INSURANCE COMPANY P.O. Box 328 55060' 333 -4949 : 3v:i{ Kv ••;•» •..FK:v•: `q r�•? . k i •<..h.'.��}f a • n,\.:.v-:;:.l. : ::n. n«- .A.- :: re.r.� , , y ... • : \ AS A MATTER OF RIGHTS UPON THE DOES NOT AMEND. AFFORDED BY THE POLICIES •.r« . v ... DATE 041.•.x1• »5•f«• »•<0 «• « ,I :�HY,l44: )}C•firL,ri}Sv.<$n • PRODUCER FEDERATED MUTUAL Home Office: Owatonna, MN Phone: 1-888- THIS CERTIFICATE IS ISSUED ONLY AND CONFERS NO HOLDER. THIS CERTIFICATE ALTER THE COVERAGE INFORMATION CERTIFICATE EXTEND OR BELOW. COMPANIES AFFORDING COVERAGE • COMPANY FEDERATED MUTUAL INSURANCE COMPANY OR A FEDERATED SERVICE INSURANCE COMPANY JAFE CONTRACTING COMPANY 253 -812 2 240 N DIXIE HWY UNIT 19 HOLLYWOOD FL 33020 I COMPANY ' B COMPANY C . COMPANY D • :- ,:a.�.:..,,.:•:.f. r: :ro•a......: ,•- <::•.:•:•. -� -r :< r:::.:..:..r..r - >. . >•r. .a .. �.:<.:•::,••:.•:..• aa::.::• h: ...<.r•• < :::•::•.•:r:.:.•...:.• ...�<... -. `::-'•:: }S:f .v S:rE< • C ?v: .t. q,+.e{h:'-�f {•Y:"•i�. . ..}02, < v i[�i: i:. rvT.- i < <:'ii•'' -a : }�2:' }- 'r' r .,x' .. vvCv,}„hc;h .r : -...E l -'-•:, •Yv• 5,..:: 2r.<.\•:iY:?"•.- fE,; ?9 .. :.. : v5 ,.:;2 : . f rsfz•?c.. .. .?i <v :. ..y � i?•T° :rGi.:•i.L+'+v: .f -v.fir 'p : .:E..,-• ...•E -a :.g«.;,::::::#5,4;-,. „i ••r• .. ...+:i:• {rv.,.0 •,,.v ..: :.-_.?.•r ..i ?i :..-.:?+• , }.f?, , •.a.J E:? 4y: €4 .r•�..L.:fw vii. 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L•} i:: J: i? i $!£?c':. } <'r,Ii::v�5it'u•'•.�tiX rfifiv}:-” n '•fa-::•fi ?i= ii= 4hl'-%•:: &�ss'�Z a°.4 >i.4.eii��e$ 4�. .�•',�y: r �w�,\': \1\<>IvaiW �id��.:�i: <viv v.�.lvt.•`S�Ji<..fa'}.'tTnvLv6< .v4e THIS IS TO CERTIFY THAT THE POLICES 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. co LTR TYPE OP INSURANCE POLICY NUMBER DATE (MANDDN'll DATE (MMIDD%YY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY PROT 9134759 05/27/10 05/27/11 GENERAL AGGREGATE 8 2,000,000 PRODUCTS - COMP/OP AGO $ 2,000,000 ">< I CLAIMS MADE X OCCUR PERSONAL & ADv INJURY $ 1,000,000 5 1.030,000 OWNER'S & CONTRACTORS BUSLNESSCENPERS POUCY EACH OCCURRENCE — X FIRE DAMAGE (Any are Bret $ 50,0)0 MED EXP (Any are pe+sad 8 A AUTOMOBILE LWBIUTY AKY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 9244715 05/27/10 05/27/11 COMBINED SINGLE LIMIT $ 1,000,000 X BODILY INJURY X BODILY BO almfdentl X PROPERTY DAMAGE 8 GARAGE LIABILITY ANY AUTO AUTO ONLY • EA ACCIDENT $ OTHER THAN AUTO ONLY ;ig? °;`iN:fF;-r•F': ;a: <':'.%7 EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM EACH OCCURRENCE 8 AGGREGATE $ $ A • WORXHIS COMPENSATION EMPLOYEE' LIABILITY THE PROPRIETORS PARTNERS/EXECUTIVE OFFICERS ARE AND INCl. EXCL 9134760 05/27/10 _ 05/27/11 qt X I W STATU I 1 7O LIMITS ER "� •v � l::? uefx�.hA EL EACH ACCIDENT 8 100,000 EL DISEASE - POLICY U $ 500,000 8 100,000 X EL DISEASE • EA EMPLOYEE OTHER DESCRIPTION OFOPEWTI A ITEMS �. u� s❖ mera < }v s.,3'.. .-:..:e F .. •' . }. nc«4:, ' >:n� r S:-E',.F ::te vrH,. • ?.;o . N ,'.: <:. r.•. ::-, : #1614117 tl i� t+ wa :<}a MIAMI SHORES VILLAGE 7 10050 NE 2ND AVE MIAMI SHORES FL 33138 • v+S •'Lr: ,.. _ ..ri: 'fiw,r.}v r.> �.. :;.. v...: >•�:i.:' ?}}T' -Y. a ^ }'f. •'rR' ..;. -•r •4 »:..� < }: •,: y �xnixcr :vaS.v .�{e.:,. }�,: L•.y?<}v <`«<Ye -f-rr }?,r�va'vv..� �:Y.:•f_S.i<�:Y`..r9 <.za:' -L-: a.< � .:eS• }''t�•.'�•'v�•.v �ytj \ }Y ::;-I •,;.�• c., Fro :,ES I..r. }•t. •0 :p >: 4.;r.1: ?.v -.:nv: x r r- L'•9 ?.e;:C} °:i F: �SS✓.a.,aa,. -:: vr. <'•}:}5:., .l ?:i'S'.is,`ry .:::*�.•a?i`�vF,•l,<m»: v',vv- .��i,vl"�f�i+�..:Sr: ::::>E� ? <.•_.Lry:.�r;h }:<:• _• },Gi:�rrfssa:;�.ev.E•.at. M�•.vb: b,�. a, :.:.:... ...•:. .. .v.h «. ».. .. ...E�:d? +Y .3::- `.sraPtfiv:: fi:Y.s,�- h n t .. „r ,r u.•<•.• .. -�.- t�. SHOULD ANY IDTPIRATION 10 DAYS fif i, wg?'�.:; 3^ :<� � l:Wxx k a}}t. >b_<. - �i:: _�• v} • }�f« }L 4? �v24�rS: a v< '<i: � OF THE ABOVE DESCRIBE' POLICIES BE COUNNELIED MOM THE • DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL WAIUEN NOTICE To THE CERTIFICATE HOLDER NAMED To THE LEFT, TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY UPON THE COMPANY. ITS MEWS OR REPRESENTATIVES. BUT FAILURE OF ANY KIND AUTHORIZED REPRESENTATIVE i'`k' .. ?IIJivY ti<L!,..:a _ 5�•n >::Y : :•<...: ?< - :.Y.r:- ' {ygrr _ ;.:yF•,v�y 3�.jlarTSV�r - .: t:•:'-i}ri ,- .• R'.,??vy�,,tif:e' }JYiL•Kvfn::. n?::?:y:: ✓:vh..-:�tivFr• -i. .�} .?. ;: <;. +..4 }:. `L`�i :.< :,. \EL•.sv: . A eh.Vr vai:_n,:�.:v'.a-.'•�•a ...... ::ri•L� �� rnn ...•..«✓S9t:�� %iIn ^a'�^•�^ -.. •...'•-�-••:� Crx' -ly? x1''o`'•`s'j.t. � ••�'' S.i:...v.,. Yf- '�. tj 5. 28. 10 IvU -55 P 6 E. Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 pOISIIIFIE% MAY 2 6 2010 BY: ..r•�•.••. Permit No. �t =11 1 10 9.41c Master Permit No. nI& Permit Type: Electrical j Owner's Name (Fee Simple Titleholder) BourrL( LA ili Vi rs I + Inc, Phone # Owner's Address 1 13 • NE E aid Cl . City �� � rid State Zip 33 i& Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) J1 /O t E_ lui a 3 , City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Ii al 3 (QC I OJ1 0 " / 7 Is Building Historically Designated YES NO Contractor's Company Name J "' PcF . 1/K --�1 ` C £ Phone # Contractor's Address at-kb jV , ) t x t -e_ l y. *1.49. City \ \\ l3 O OC� State FL..._ Zip s a10 Qualifier Name L_ A y- Ae S�-�. Phone # State Certificate or Registrltion No. T.11X2A. 13 '1 V Certificate of Competency No. ®5° -c.n.& e —1 1514 "J` E -MAIL: 3th SA CD n a-ctak; ei 5 . CO rek Architect/Engineer's Name (if applicable) Phone # gsLI- claA4z4za gC5L4 —ugS VI C. Value of Work For this Permit $ i 76 ®D Type of Work: ❑iAddiition ❑Alteration Describe Work: /a kid C 6 /e.c •,c Square / Linear Footage Of Work: ['New 1 j --4 air/Replace ❑ Demolition *,.,t+Ya***** *a**** *+k*x*** * *+ Yet ****** *'e+ *** Fees * ********** * **ie*ie***** **** *** **** * * ** *,rye**** Submittal Fee $ Permit Fee $ 2 CCF $ q' 0� CO /CC Notary $ Training/Education Fee $ 1.40 Technology Fee $ 5(013 Scanning $ (D•00 Radon $ DPBR $ Bond $ Code Enforcement $ Double Fee $ Zoning $ Structural Review. $ Total Fee Now Due $ See Reverse side -› 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 seven (7) days after the building permit is issued In the abs ice of such posted notice, the inspection will not be appro ed a reinspection fee will be charged Owner or Agent The foregoing instrument was acknowledged before me this day of ,AA y ,20 to , by VAA C6 9kris who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: et\ Sign: Print: My Commission Expires: Signature Contractor The foregoing instrument was acknowledged before me thisacd day of t°a ( , 20 b b , by Jca`iiuc . L , who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Ex **************************** *************************** * * * ** * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: (Revised 02/08/06) Plans Examiner Engineer Zoning Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No: 99. /t G fe, Job Name: � 2-/Z ,'LNG /"z le ,209 Page 1of1 ELECTRIC Critique Sheet / 2 - - Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Mike Devaney 305 - 795 -2204