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MC-11-770Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 159048 Permit Number: MC -5 -11 -770 Inspection Date: May 16, 2011 Inspector: Perez, JanPierre Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Library 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 -03 Phone: (305)756 -6501 Building Department Comments REPLACE '-'24 5 / LC % Passed Inspector Comments M Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 May 16, 2011 Page 1 of 1 BUILDING PERMIT APPLICATION Master Permit No. FBC 20 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder) RAM'/ IA NW& (fig( Phone # Owner's Address d Vii♦ k �� r Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 It tAY 0 3 2011 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 No. mx, t l —1 City Ai Am Elio /Vac Tenant/Lessee Name Email State FL Zip "g,31 Phone # Job Address (where the work is being done) 11 300 N 2/.0( AvG — U 6 2)(/ City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # Is Building Historically Designated YES NO Flood Zone Contractor's Company Name U l lr- yo II Contractor's Address al' £5 „Ai �(a� 1 I C C City r ,t)ti tit d L) (L' t State Phone # 0514 5)5 R (1g-d Zip Qualifier Name I f 1 % h /� ke. o C-L f Phone # State Certificate or Registration No. Cy-low (" J &'L) Certificate of Competency No. 1 J -.J316211 Contact Phone 461-- -f (I ., 00 E -mail Lien s=i-v0 h l 1 I ti V m a ear) Architect/Engineer's Name (if applicable) Ni ) !4 Phone # Value of Work For this Permit $ 9 ij( %i? Square / Linear Footage Of Work: Type of Work: DAddition DAlteration DNew ❑ Repair/Replate ❑ s emolition yy 1f. Describe Work: � ? M�`�( �,1� �������� meth C.� ��� I � ll " � �' � - ��� .�� ; �� ****** * * * * * * * * * * * *** * **** ******k * **** * *F ee *** * ****** * Y *aY*** Y** **:F** **9: ****k* *** Submittal Fee $ 7 Permit Fee $ ry F �j �' * CCF $ CO /CC $ Notary $ Scanning $ Radon $ Double Fee $ Training/Education Fee $ DPBR $ Structural Review. $ Violation date: Technology Fee $ Bond $ Total Fee Now Due $ See Reverse sid 5/2[ 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 0 F 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 approved and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of ANAL- , 20 :I , by MAO; (Z-N Q who is pet. known,to me or who has produced As identification and who did take an oath. rtf- NOTARY PUBLIC: Sign: ditAika 10 �I Aar Print: 9 ..`��:±,.s- .•t�.iit My Commissio ** ****** * *********** * ***f * ** * * APPROVED BY Signature j 1 " " _ �E Contractor The foregoing instrument was acknowledged before methisJ1 day of M (1,4 4 , 20 , by J \[au L V)t r who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: !� Print: My Commission Exp * * * * * * * * * * * * * * * * * * * * * * * * * ** lans Examiner (Revised 07 /10 /07)(Revised 06/10/2009) Engineer Ypd9 YARISMAR C - ` MY COMMISSION # DD702722 Or ct EXPIRES August 07, 2011 407) "8 Florldallota ervice_com Zoning Clerk checked A °® CERTIFICATE OF LIABILITY INSURANCE DA3/31/2011m 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 policy(les) 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 certifcate holder In lieu of such endorsement(s). PRODUCER Seitlin Insurance 6700 N. Andrews Avenue #300 Ft. Lauderdale FL 33309 CONTACT NAME: (A/CNNo.Ext): (954) 938 -8788 FAX ,No):(954) 938 -8566 &MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:PA Manufacturers' Assoc Ins. Co. 12262 INSURED Hill York Service Corporation 2125 South Andrews Avenue Ft. Lauderdale FL 33316 INSURERB:National Union Fire Ins Co. PA 19445 INSURER C: Evanston Insurance Company 35378 INSURERD: $ 1,000,000 INSURERE: $ 300,000 INSURER F : CLAIMS -MADE COVERAGES CERTIFICATE NUMBER: Cert ID 28179 REVISION NUMBER: 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. INSR LTR OF INSURANCE ADDL ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 301175 33- 95 -25 -8 4/1/2011 4/1/2012 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurrence) $ 300,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 R Per Proj /Per Loc Agg PERSONAL &ADVINJURY $ 1,000,000 X XCII /Contractual Liab GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE 7 POLICY X LIMIT APPLIES JECT PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE X X u aiuTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS 151100 33- 95 -25 -8 4/1/2011 4/1/2012 COMBINED SINGLE LIMB (Ea accident) $ 1,000,000 BODILYINJURY(Perperson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ g X UMBRELLA LIAB EXCESS LU1B X OCCUR CLAIMS -MADE 3E26159447 4/1/2011 4/1/2012 EACH OCCURRENCE $ 10, 000, 000 AGGREGATE $ 10, 000, 000 DED X RETENTON$ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y/N N / A 201100 33- 95 -25 -8 4/1/2011 4/1/2012 WC STATU- 1 1°T11- X TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1, 000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Pollution Liability 10CPLC00621 4/1/2011 4/1/2012 General Aggregate $ 3,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) PROOF OF INSURANCE ONLY. CERTIFICATE HOLDER CANCELLATION City of Miami Shores 10050 N.E. 2nd Avenue Miami Shores FL 11111 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDREPRESENTATIVE y . -.+dv ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD