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ELC-11-1613
Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 nspection Number: INSP - 163992 Permit Number: ELC -8 -11 -1613 Inspection Date: October 27, 2011 Inspector: Devaney, Michael Owner: SCHOOL INC, MIAMI COUNTRY DAY Job Address: 107 ST AND 6 AVE STREET IRIDDA\ /CSaC61T eE -....F Miami Shores, FL 33138 -0000 Project: <NONE> Contractor: STRYKER ELECTRICAL CONTRACTOR INC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)759 -2843 Parcel NUMPROVEMENT PROJECT Phone: (772)2194389 Building Department Comments ENTRY WALL Passed Inspector Comments v _ -- /� Failed C /C-/ // Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 October 27, 2011 Page 1 of 1 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ..•••.•...• •• ° °° ° °• 131°. INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING 111/14 PERMIT APPLICATION FBC 20 Permit No. Master Permit No. C ( - it - s «3 Permit Type: Electrical OWNER: Name (Fee Simple Titlehold er): M a• �® �- �� '� Se L / Phone#: 36 - — 2 s 9_ 8 `lam Address: 6 ' e I E /0 `7 c i t y : t ( c e , 5 Cam. IL os State: I Z- Zip: 3 3 S -ts c)e Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: `C2 '73 /4-/ City: Miami Shores County: Miami Dade zip: 3 31 33' Folio/Parcel #: Is the Building Historically Designated: Yes NO bL Flood Zone: CONTRACTOR: Company Name: c-(1 KeV Z 0e i1v141- f 9 A 1� v YC � t1 Phone #:1 ) 2 °2 I9 -33 Address: 1 a City: Thh1n C +-4 State: P I Qualifier Name: Tay() 1i p QA )f- h 1-te State Certification or Registration #: R11300 3(435 Certificate of Competency #: Contact Phone #: 7/ 2-214-336c1 Ez i-I90 Email Address :. �i � 1 cck, C S} d�I+�>et( -� I�P� °Fr u .CO rv." DESIGNER: Architect/Engineer: Z y ('o ca , `r I-1- / M r JJS f 2 ec, F Phone#: Zip: 39e1610 Phone#: 549/ -7729 -qq2 2 Value of Work for this Permit: $ se) ✓ E'g'o Square/Linear Footage of Work: ` f `"` Type of Work: Address DAlteration New ORepair/Replace Description of Work: p--- n y L - °- ! 1 Demolition *** *+ x** x: ***+ x** * **** * * * ***m************* Fees*** a:********** *+ x***u: ****+x*** ****** *** *x°***** Submittal Fee $ Permit Fee $ 9'421'8 4'47 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ gm: Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's,Address . e w z 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 approved and a reinspection fee will be charged. Owner or Agent `` The foregoing instrument was acknowledged before me this 5' day of C1 , 20LL, by Gi pex7 5107-) who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: S ✓1eit Signature 41/Ke44 Contractor The foregoing instrument was acknowledged before me thi Y day of , 20 I I , by TO iov P - L, t it IS,. who is p onally known to . - or who has produced NOTARY PUBLIC-STATE OF FLORIDA Shellie L. Fulford • Commission # DD850330 ,,,•• •'" Expires: FEB. 28, 2013 BONDRD TIM ATLANTIC BONDING CO., INC. * ** g ** ***** ** ** ****** * ** * sic* *** * $ * * ****** *** *** ** * ** *** *** ****** My Commission Expires: *,k,B,R,R Ne **** *,R **,k*** ** * * APPROVED BY as NOTARY P ,1 Sign: Print: My Commi • 1F entification and who did take an oath. IC: Gv'i. SCOTT ECC!$ ioN� r_ S. MY COMM:SSg : CE 027824 EXPIRES: 0+ +,Plet 5: 2014 Bonded Thru Nota [a: -rt:r: Underwriters / % Z'P // Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk Miami COUNTRY DAY SCHOOL August 26, 2011 Miami Shores Village Building Department RE: 601 NE 107th Street, Miami, FL 33161 To Whom It May Concern: Mr. Gary Butts, Chief Operations Officer, is an authorized signer on behalf of the corporation, Miami Country Day School, Inc., owner of the above addressed property. Sincerely, Anne Paulk, President Board of Trustees Miami Country Day School, Inc. NOTARY PUBLIC-STATE OF FLORIDA Shellie L. Fulford Commission #DD850330 Expires: FEB. 28, 2013 BONDED THRU ATLANTIC BONDING CO., INC. 601 Northeast 107 Street I Miami, Florida 33161 1 305.759.2843 I Fax 305.759.4871 I www.miamicountryday.org Every Student. Every Day. SEP -08 -11 THU 03:05 P11 FAX NO. P. 01 CERTIFICATE OF LIABILITY INSURANCE 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 13Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOE 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, tho poliey(ies) must be endorsed. If SUBROGATION 1S WAIVED, subject to the Germs, and conditIonS of the poBCy, certain policies may require en endorsement. A staterent on this certificate does not confer rights to the certificate holder in IICU of such endorsement S). PRODIJCEN Co11 i>nBWorthr 23 Ec)a1a.fu.tket Street Suite 102 DATE (MMIbp/YYyy) 6/3/207.3. Alter, Lambert, I,LC CONTACT' NAME: Pe9.9Y FLoaf PHONE {561)776 -9001 -(i N�,nt,111 a-MAIL sroaf @ca111c.com ADDRESS: PRODUCER 000265$ CUST.OMF.EJD N: w_ 'Oup ?t x FL 33477 INSUR! R(S1 AFFORDING COVCRAI NAIC N 1NSUrsrrtr • - - -- ....._. INSURES IFCCY Xnsuxance Group INSURER $ : IN3URER C : INSURER D INSURER E : INSURER F • COVERAGES CERTIFICATE NUMBER:6 /1 /11 Cora Celt WC Only REVISION NUMBER: THIS IS TO CFRI IEY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICAT LO, NOTWITHSTANDING ANY REQUIREMENT, 1IdRM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CFRf)FICATE MAY tit: ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 10 ALL THE TERMS, F.XCL U31UNS AND CONDITIONS 05 SUCH POLICIES. UM11S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - • -- -, —17-4X (66.0427-6/30 -(Arc, No - Stryker 8100trica] Contracting, Inc. 4247. Southwest High Meadow Ave e Palm City >'Xe 34990 HNULi5UL1 f{ LTk Tl'I'C or INSURANCE 1145,R ! WVD POLICY NUMB 6R (POLICY //YYYY) fMMIbD /,.YyJ, Laura GENERAL LIADILITY • 21 p.OMMERCIAL GENERAL LIAP111.11Y 1 CLAIM': -MA0t: L J occur GENT Ar:CRJ:CATC LIMIT ArpLIF „$ p(-N room', r ^ Irnc>. hoc _�Jk(:1 I � 1 AUTQMOIni CIA-Barr? ANY AUTO ALL OWNr•OAUrOS SCI Irrlut r p ALIT OS MU ;ED AUTOS NON -0WNti AUTOS (1MBRELLA LIAR 0=1It, I?XCELSLIAD CLAIMS -MAbCI • DCDLICIIDLC — - —lT 1i6.1tNrION A WORKERS CObMPtP13AT10N ANn EMPLOYERS' LIADILITY ANY Pnorr,ICTORlPARTNCRrEXCCUTIVE Y / N Orr ICCR1M,MSEn Excl. Uj)EDr N1A (Mandatory In RN ocatiC11A65608 4/L /2ell if 10, den.e,i1�4 writ” nr.:�rrlr'l ION 01 Crl'LRATIONS brnnw EACH OCCURRENCE $ "ETAlgrAVE 10 MERTIC _PRemISES,(C,i¢_psurmncrl 5 -. -- . -.- MED EXPIAny enn enreen) i $ PERSONAL 8 ADV INJURY $ GENERAL AtiOREGATE $ I PT RODUCTS . COMP/0Y AGG 5 COMBINED SINGLE UMrr (Es accidenl) NOOILY INJURY (Per percgn) $ - t10DILY INJURY (Per eceideriL) $ PROPERTY DAMAGE (Per anciduru) S j EACN OCCURRENCE ACCREOATC $ WC Tai )oTH. E,L PACHACCIDENT LF $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1 L0 00 , 000 E.L. DISEAt3 - POLICY LIMIT 5 Dr-SCRIPT ICON OF OPERATIONS/LOCATIONS r VEPIICLL• 6 (Amon ACORD 101, AddiUonat Ram mer SehoduIe, 0 n,ore e:paea i raquirad) _CERTIFICATE WILDER 000,000 CANCELLATION ?Miami Shores Village Suit Ling ,Aept 10050 NE 2nd Avenue Miami Shores, FL 33138 ACORD 25 (2009109) INSf17Fi r9nnanai SHOULD ANY QF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH TI-IE POLICY PROVISIONS. AUTPIORIZED REPRESENTATIVE Peggy Reef/BETE x1988.2009 ACORD CORPORATION. All rights reserved. The ACORr) name) And Innn ern rrrnistnrnr) markc of A(;flPfl SEP -08 -11 THU 03:05 PM FAX NO. CERTIFICATE OF LIABILITY INSURANCE OP ID TJ 06 0 11 HIS CERTIFICATE IS ISSUED As A MATT TrOF INFORMATION ONLY AND CONFERS No RIGHTS UPON THE CERTIFICATE OLDER. 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. P. 02 bATE(MMJDDIyyyY) TQ tort care oI er s an °� ? T - ,, a policy(ie5 must o en • orsed. $ : ` • ••' "' • ` T • T, su •'ect to Je term& and conditions or the policy, certain policies may require an endorsement. A statement on this certificate dons not confer rights to the certificate holder In lieu of such endorsement(s). P•ODUCEf3 Stuart Insurance, Inc. 3070 S W Mapp Palm City FL 34990 Phone 772- 286 - -4334 Fax:772 -286 -9389 STRYKER ELECTRICAL CONTRACTING Palm Cityy'yhFL Meadows Ave COVERAGES 4�a lug: - NAME: Rick Holcomb r >w EN 772 - 286--4334 —Eric, No): 772 - 286 -938 1ESS: hl ADDRESS: xacomb @st:uartinsuranc ®,net PRODUCER CUSTOMER ID dl; STRYE -1 INSURER(S) AFFORDING COVERAGE NAIC_p 12 INSURER At Westfield Insurance 241 INSURER tT : INSURER C: INSURER D; INSURI_R E: INSURER F : CERTIFICATE NUMBER: • THIS 1810 CE.HritYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE PEEN ISSUED TO HE INSURED NAMCD ABOVE FOR THE POLICY PERIOD ^• INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OP ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE; DR MAY PERTAIN, TI I1 INSURANCE AFFORDED BY TI 1E POLICIES DESCRIBED HEREIN IS $UITJI CT TO ALL THE TERMS, L EXCLUSION$ AND CONDITIONS OF SUCH POLICIES. LIM1Ts SIIOWN MAY HAVE BEEN REDUCED pY PAID CLAIMS. B R T^ ADD S 'mum- TYPE or INSURANCE IN TR WVD POLICY NUMBER TRA6076667 1-i- (W A/DD/YYYYI 06/01/11 POLICTEXP (MM/DD /YYYY) 06/01/12 o6 /oi /12 LIMITS A _ G8W X _ _ - RAL LIABILITY COAAM$RCIAL GENERAL LIABILITY I _ j CLAIMS -MADE 4 J OCCUR EACH OCCURRENCE $ 1,000,000 ''17A 1AGE TO RENTED PREMISES(Eseccurreneu) $ 150,000 MED EXP (Any 0 person) $ 10 000 PERS0NAL3 ADV INJURY GENERAL AGGREGATE $ 1 , 000, 000 52,000,000 � — GCN'1, AGGREGATE LIMIT APPLIES PER; PQLLCY f x 1.Pie .1,.....1221C PRODUCTS • COMP/OP AGG -•- $ 2 , O00 000 r COMBINED SIN LEA LILT (C�oaeddonl) $ S 3.,000,000 '• AUTOMOBILE . - - _• ^ LIABIIJTY ANYA1JTQ ALL OWNED AUFOS SCFICbUtNO AUTOS Hlnrn AUTOS NON- 01/04:U AUTOS TRA6076667 oa /81/11 BODILYINJURY(Perpa/son) $ BODILY INJURY (For occidonI) $ PROPERrY D MIJ\GE (For aooldenl) $ $ A ' ' g UMBRELLALEAD Exco8sUA8 ][ OCCUR CLAIMS•4nADe '�RA6076667 06/01/11 06/01/10 EACH OCCURRENCE 8 4,000 1.900 AGGREGATE $4,000,000 X DEDUCTIBLE RETENTION $ 8 $ WORI(ERB _0 COMPENSAT10N ' — N /A AND EMPLOYERS' LIABIUTy ANY 1 ROPRICTOR/PARTNCR/EXCCUfIV' Y / N OFF:CERAVEMn[R EXCLUDED? (Mandatory in NH) If yoa dr, r ibo under DEBfRIPT1DN or OPERATIONS below 1 WC STATE 1OTH• TORY L ER E.L. EACH ACCIDENT ACCIDENT 5 E.L DISEASE • EA EMPLOYEE 4 EL DISEASE - POLICY LIMIT 5 A OWNED EQUIPMENT & RENTED OR LEASED TRA6076667 06/01/11 oB /o1/1z SCHEDULED DED $1000 RENTED /LE $150,000 DESCRIPTION OF OPERATIONS 1 LQCAT1oNS / VEHICLES ELECTRICAL WORK (`.FraTIMI-1,eTC two nose - Ansel ACORD 101, Additional Remarks Schedule, If more specs Is required) ANCELLJATION Village of Miami Sharea Building Dept 10050 NE 2nd Ave. Shores FL 33138 VILLMS- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 8E CANCEI.LQb BEFORE THE EXPIRAT10N DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE / © "- 88 -2009 AC ACORD 25 (2009109) The ACORD name and Logo are registered marks of ACORD /lik J I , .• a `- RATION. MI rights reserved.