ELC-11-1899Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
I i ,- I l'13
j 1 4qtro
Inspection Number: INSP- 167298 Permit Number: ELC -10 -11 -1899
Scheduled Inspection Date: December 05, 2011
Inspector: Devaney, Michael
Owner: SCHOOL INC, MIAMI COUNTRY DAY
Job Address: 107 ST AND 6 AVE STREET
IaaDDA\ /CAaCAMT 04....4
Miami Shores, FL 33138 -0000
Project: <NONE>
Contractor: FOREVER SIGNS INC
Permit Type: Electrical - Commercial
Inspection Type: Rough
Work Classification: Sign
Phone Number (305)759 -2843
Parcel NiiMPROVEMENT PROJECT
Phone: (305)885 -3411
Building Department Comments
Electric for letters
Passed
/
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
December 02, 2011
For Inspections please call: (305)762 -4949
Page 35 of 46
Miami Shores Village
Building Department
90050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
17 PI
OCT 1 4 2011
BUILDING Permit No. 11 / /°' /L' G f
PERMIT. APPLICATION aster Permit No
' 1�
FBC 20
Permit Type: BUILDING R9OPING
sc1 e 3e- - 2 72- 102
OWNER: Name (Fee Simple Titleholder): � � � v� 1 " ( � �: -- c-> ra � �, Phone #:
Address: (90 / E 110 `7 " ,5
City: J 6 ke A e-s State: I
Tenant/Lessee Name: �� Phone #:
zip: 33/6 l
Email:
JOB ADDRESS: 6, c / its e_e- ie, '7 "3-1,,
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
NO ► Flood Zone:
CONTRACTOR: Company Name: ro e (1✓ S E�� S Phone#: 30 S — Se J - .3C0(
Address: 2.4 DO W c.4 4
City: IVA. tA State: FL
Qualifier Name: R e-C / \ A t ua re Z Phone #: os -13P ' 3 � t (
State Certification or Registration #: & - 1.300 3178 Certificate of Competency #:
Contact Phone #: 103-19 sS'_ 3 `E l ( Email Address: c® �V - s+S M `- _ ��°
DESIGNER: Architect/Engineer: Phone #:
Zip: 3310
Value of Work for this Permit: $ k4 20,00 Square/Linear Footage of Work:
Type of Work: DAddition ❑AlterationTew DRepair/Replace
Description of Work: Pwv5 a /Lc L 4&s 'r7
**** ***** * * * ***** ** * *** ** * * ** **** ** * gea*********** **** * * ** ** * *** * ***** ** * * * * *****
Submittal Fee $ Permit Fee $ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
5 '<DO
•
.. I .: v ing 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 approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent th
The foregoing instrument was acknowledged before me this Z. $ The foregoing instrument was acknowledged before me this
n� VII/
day of Sept , 20 j, by �" y 160 'P%�.S , day of O L , 20 11 , by i t ALO '-
who is personally known to me or who has produced who is personally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
ghte46/t■
Sign:
Print: & /SE14 Aamkrb
APPR1V
-
Examiner
%`0)6 l/
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
NOTARY PUBLIC:
ROBIN PEREZ
VZoning
Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 7952204
Fax: (305) 756.8972
CONTRACTORS' REGISTRATION FORM
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS
SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR.
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. _COPY OF QUALIFIER'S STATE LIC CARD
B. ✓ COPY OF LOCAL BUSINESS TAX RECEIPT
C.
COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT)
D. 11/ COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTOON)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. COPY OF LIABILITY INSURACE JCERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT)
D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION)
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME: Fc eve_f SvinS
BUSINESS ADDRESS: 2_400 W 3 RD C or+ CITY .1-1 ►Q leap,
STATE FL.. ZIP CODE 33o t o
BUSINESS PHONE: ( 505 ) $ $ 5 - 3411 FAX NUMBER ( 305) g5 - 3 L4 (<JCo
CELL PHONE ( )
QUALIFIER'S LIC NUMBER:
QUALIFIER'S NAME: Parcel A . Alva
EC. 1C3C)
E -MAIL ADDRESS (IF APPLICABLE): 'k) re ve r S I9 trlS Ci) Go( CO m
Created on 3119109 BY MLDV 1 RV 3126109 MLDV
AC#
7122/20:IT:
•G
el, •••,A,,z,.
...7_J'Ate '4c6124
10.6041026;„
FSC
MixedLources
ENVIRONLIENTALIX sat:Lary
Mayor Carlos Hernandez
PRINTED WITH tete,. ICSVOC.02723
FRIENDLY GREEN INKS
City of Hialeah
Business Tax Receipt
No: 238210-20
2011-12
(OLD-17311160) Amount $ 150.00
The person, firm or corp. listed hem has paid the business tax required to engage m or operate the business specified subjectto the
regulations and restrictions of the City of Hialeah, Florida
Owner: RAFAEL ALVAREZ - FOREVER SIGNS, INC.
Type of Business: Electrical Contractors and Other Wiring installation Contractors
FOREVER SIGNS, INC
2400 W 3 CT
HIALEAH , FL 33010
Validating No. : 0000
Business Location:
2400 VI 3 CT
Expires September 30, 2012
THISISNOT4 BILL
City of Hialeah
FSC
Mixed Saurus
Business Tax Receipt
PRINTED WITH Ceaso.SCS-CSICS2X05
FRIENDLY GREEN Rocs _ Mayor Carlos Hernandez
BIVIRONMENTALLY
Amount $ 65.00
No: 339950A2 (OLD —3993A41 )
The person, firm or corp. listed here has paid the business fax required to engage in or operate the business specified subject to the
regulations and restrictions of the City of Hialeah, Florida
Owner: ARTURO VIZCAINO -FOREVER SIGNS, INC.
Type of Business: Sign Manufacturing
2011-12
FOREVER SIGNS, INC
2400 3 CT
HIALEAH, FL 33010
Validating No: 0000
77IIS IS NOT A BILL
Business Location:
24013 W"3 CT
Expires September 30,2012
'Oct 12 2011 S:58RM HP LASERJET FAX
CERTIFICATE OF LIABILITY INSURANCE
p.3
DATE (MWDD/YY)
10/12/11 -
PRODUCER Chaplan & Castro Insurance
2552 NW 7 Street
MIami, FL 33125
Phone (305)541 -4009
Fax (305)649 -1513
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
NAIC A
INSURED FOREVER SIGNS ,INC
2400 WEST 3 CT
HIALEAH . FLORIDA 33010
INSURER A:ATLANTIC CASUALTY INS. CO.
INSURER B: CASTLE POINT INSURANCE CO.
INSURER C: PROGRESSIVE INSURANCE CO.
INSURER D:
INSURER E:
COVERAGES
INSURER F:
THE POLICIES OF INSURANCE USTED HAVE BEEN ISSUED TO :THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTYRIHSTANDINO
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMIENTIMTH 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. •
DISK
L
ADM
TYPEOF'DISURANCE
POUCY
POLICY EFFECTWEI
DATE MIWDDIYY
POUCYaxP ATION
DATE 1 .
LIMITS
A
GENERAL LIABILITY
1% COMMERCIAL GENERAL LIABILITY
•
L190000032
03/02111
03/02/12
•
EACH OCCURRENCE
1.000,000
PREMISES ( o RENTED
100,000
• • CLAIMS MADE ® OCCUR
MED EXP (Any one person)
5,000
•
❑
PERSONAL & ADV INJURY
300,000
❑
GENERAL AGGREGATE
300,000
GEM L AGGREGATE LIMIT APPLIES PEFt
❑ POLICY • PROJECT ❑ LOC
PRODUCTS - COMP/OP AGG
300,000
B
❑
AUTOIYOBLE LIABILITY IY
037550933 -2
12/15/10
12/15/11
COMBINED SINGLE LIMIT
(Ea accident)
100,000
• ANY AUTO
❑ ALL OWNED AUTOS
BODILY INJURY
(Per)
300,000
•
Ii SCHEDULED AUTOS
❑ HIRED AUTOS
❑ NON OWNED AUTOS
BODILY INJURY
(Per accident)
50,000
•
PROPERTY DAMAGE
(Per accident)
❑
•
GARAGE LIABILITY
• ANY AUTO
AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
❑
AUTO ONLY: AGG
LIABILITY
• OCCUR ❑ CLAIMS MADE
•
EACH OCCURRENCE
AGGREGATE
•
• DEDUCTIBLE
• RETENTION 1
C
WNOFBCERS COMPENSATION AND
EMPLOYERS*UABLrTY
ANY PROPRIETOR / PARTNER / EXECUTIVE
OFFICER /MEMBER EXCLUDED?
I/ yes, describe under
SPECIAL PROVISIONS below
WCP780507801
09/24/11
09/24/12
II WC STATU II OTH -
TORYLIMITS ER
E.L. EACH ACCIDENT
1 00,000
E.L. DISEASE - EA EMPLOYEE
100,000
E.L. DISEASE - POLICY OMIT
500,000
OTHER
DESORPTION OF OPERATIONS! LOCATIONS !VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
MANUFACTURING & INSTALLATION OF SIGNS
CANCELEA
MIAMI SHORES VILLAGE BUILDING DEPART
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXP 1 TION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
THE BUT FAILURE TO DO SO SHALL IMPOSE NO OBU - TION OR LIABILITY
OF ANY ' . UPON THE M:URER ITS A r+ ATIVES.
AUTHO < < • :+ ATIVE I
ACORD CORPORATION 1988
MIAMI -DADE COUNTY
TAX COLLECTOR
140 W. FIAGLER ST.
1st FLOOR
MIAMI, FL 33130
2011 LOCAL BUSINESS TAX RECEIPT 2012
MIAMI -DADE COUNTY - STATE OF FLORIDA
EXPIRES SEPT. 30, 2012
MUST BE DISPLAYED AT PLACE OF BUSINESS
PURSUANT TO COUNTY CODE CHAPTER BA or ART. 9 & 10
FIRST- CLASS
U.S. POSTAGE
PAID
MIAMI, FL
PERMIT NO. 231
THIS IS NOT A BILL — DO NOT PAY
627797 -4 RENEWAL
BUSINESS NAME / LOCATION RECEIPT NO. 654362 -4
FOREVER SIGNS INC STATE* EC13003878
2400 W 3 CT
33010 HIALEAH
OWNER
FOREVER SIGNS INC
Sec. T of Business
196 ELECTRICAL CONTRACTOR
THIS IS ONLY A LOCAL
BUSINESS TAX RECEIPT. IT
DOES NOT PERMIT THE
HOLDER TO VIOLATE ANY
EXISTING REGULATORY OR
ZONING LAWS OF THE
COUNTY OR CmES. NOR
DOES IT EXEMPT THE
HOLDER FROM ANY OTHER
PERMIT OR LICENSE
REQUIRED BY LAW. THIS IS
NOT A CERTIFICATION OF
THE HOLDER'S QUALIFICA-
TIONS.
PAYMENT RECEIVED
MIAMI -DADE COUNTY TAX
COLLECTOR:
07/07/2011
60090000146
000045.00
SEE OTHER SIDE
WORKER /S
3
DO NOT FORWARD
FOREVER SIGNS INC
ROBIN PEREZ PRES
2400 W 3 CT
HIALEAH FL 33010
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-34-134-C
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9740 SW Ei
WW1 FL 33/654220
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issum.03.05-20/0 fi•r 6,11
EXAREs. 0444-2018
Rest A
- litt00R5e
Miami
COUNTRY DAY SCHOOL
October 3, 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,
am."12-- d7cut.a._
Anne Paulk, President
Board of Trustees
Miami Country Day School, Inc.
NOTAyt Int8LICATATt dl PLORIDA
Shellie L. Fulford
Commission #DD850330
Expires: FEB. 28, 2013
BONDED THRU ATLANTIC BONDING CO., INC.
`•nr
D1 Northeast 107 Street I Miami, Florida 33161 1 305.759.2843 I Fax 305.759.4871 I www.miamicountryday.org Every Student. Every Day.
Permit No: 11-
Job Name:
Date:
Miami Shores Viiiage
Building Department
Zoning Critique Sheet
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Page 1 of 1
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.
David Daquisto
Planning Director
305 - 795 -2207