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PW-11-601Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 157978 Permit Number: PW -4 -11 -601 Scheduled Inspection Date: October 31, 2011 Inspector: Bruhn, Norman Owner: SCHOOL INC, MIAMI COUNTRY DAY Job Address: 107 ST AND 6 AVE STREET IAADDA\ /CSACIUT Miami Shores, FL 33138 -0000 Project: <NONE> Contractor: SUFFOLK CONSTRUCTION COMPANY INC Permit Type: Public Works Inspection Type: Final Work Classification: Public Works Phone Number (305)759 -2843 Parcel NUMROVEMENT PROJECT Phone: (561)723 -2967 Building Department Comments INSTALLATION OF AN UNDERGROUND DUCT BANK FOR FPL OVERHEAD TO BE RELOCATED UNDERGROUND Inspector Comments Passed ZJir Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. October 31, 2011 For Inspections please call: (305)762 -4949 Page 2 of 18 r3) 77-3 ; 7-77 7 ;7 ri• Miami Shore's Village APR 05 2011 Public Works Departmentr—________ 10050 NE. 2nd Avenue, Miami Shores,. Florida 33138 Tel: (305) 795.2204 Far (305) 756.8972 Public Works Permit Application FBC 2004 Penult Typo Public Warier WATER Sekenest3OS-- 172C-3. Cones Nome (Fee Simple Tillehokler) Pc‘, owners Address 15 P3 t b"? City • she:- Zip Tenant/Lessee Mania. Phone ft Job Address (Whet the work is being done) GP Ot t\)6 v57-4- 54rtet--- City Muni Shores Viltaue County Miami Dade le Building Ellstarically Designated: YES 112) Corlimeibes Company Name ccs. cr—o L 5f e_4(Ity" Orts1j044.! Contractors Address 1 Ilhorar 0�-a C r . City • Allot" et.d.G..k. State Pc-- Zip 3.3(6 Plume zip Areltilect/Enreneites Name Of meihmble) k":114."% 14 r 14".11. /FPG Phone 0: ?04.5G a2X 2 S Uneal.Foolage Of Work 1/ /oa $ Vella of Work For this Permit 4- "Ze31 000- Pr' Type of Wodc El Addition El Alteration 0 New D RpRac D Demolition Describe WIAC =IP' "OA- ElVt• et.an u-s50/Rir- ratA...ak act.c.f &Lg. k FI)e- c. rog4.44 Submittal Foe (7-) t 0 *NO 911111**1.*•• ,..,ea Permit Fee $ //6 1.J CCF1 CO/CC Notary $ TrandrtglEducallon Fee 5 Technology Foe $ Scanning $ Radon 5 Zoning Bond 5 Code Enforcement $ Structural Plan Review $ Total Fee Now Due $ (Continued on opposite side) I PoiR , s+ Bonding Company's Name (if applicable) Bonding.Company's Address N/A City • State Mortgage Lenders Name (if applicable) Mortgage Lenders Address City State N/A Zip 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 segued for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CbNDmONERS, 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 this issuance of a Public Works permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction Gen law brochure will be', - =red to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be : , at the job ske for the fast inspectibn which occurs seven (7) days after the building permit is issued in ilia absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged Signature Signature The foregoing instrument was acknowledged before me this The day ofdna/ , 2011_, by JO/?P !/l e S d who is personally known to me or who has produced NOTARY PUBLIC: Sign: ©4� Print: Shed . e as identification and who did take an oath. vr� " Sheltie L. Fulford cum>atission# ff .. 'Neal oig ,,.., .,/ Expires: FEB. 28,201 BONDED TSRU ATLANTIC BONDING CO., INC. APPLICATION APPROVED BY: 11/17/2005 Contractor •= a oing Instrument was acknowledged before m tmi ' 20 by .� l ay of � 7 �,1 1 1 ` e� o is personally know to me or has produced . ,ft� `t .e Ca oe as identification and who did take an oath. -' BUC: Sign: �■1�l.1 a P ,�f �� O Print: I ` My Commission E' LIAN ► CUM Nett o P bib • SNOW Commission • DO I13l9011 Comm. l6tplt..pt 20.2013 Public Works Director or his designee. NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF RRST INSPECTION PERMIT NO. E W- 41 % I(D Q 1 TAX FOLIO No. .30 - 223i - 021- o0.5 -o 30 -2230-04.1- oaho STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1111111 11111 11111 11111 11111 11111 11111 1101111 CFN 201 1 8.0224420 OR BI, 27645 F'ss 1131 - 1132; (2pss) RECORDED 04/07/2011 14:00:45 HARVEY RIJVIN, CLERK OF COURT MIAMI -DAC'E COUNTY? FLORIDA / Space above reserved for use of recording office 1. Legal description of property and street/address: f<C' e' / N I % 7 14140-11 FL. a o t fv 1 2. Description of improvement: th)(1.0-ci round th)t:fr +e ti dud- r-4- k / drt -rtla J e c7 r41ar eXe,f. ave. 3.Own'er(s) name and address: Interest in property: Name and address of fee simple titleholder. AA IktA1 (L .jnlTZ ()lei kto `i-- 4. Contractor's name, address and phone number c.r.1 CramtA 1• • 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number. S D ArtTACrtt dt5 Amount of bond $ i , 5t7O,000. d0 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes Name, address and phone number. f' [AiSbtf ME)ID.P% 11 IAA DA--( 60 I i4t✓ I01 541-ez:t-I f 04.44It 5,#-2 s n.. 3i I C. I 5}t 174.7222 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. �/ �f �v i/ 5(4-D ie Ave:, 1.34 MiG - F 33137 Name, address and phone number. `?�`t�jinP. l�l J--ff (�r4;.;.%.r � 9. Expiration date of this Notice of Commencement: r,Ji JUArP y 36 , (the expiration (late is 1 year from the date of recording unless a different date Is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signature(s) of Owner(s) orOwner(s)' A Prepared By Print Name 6447 ' /2771' Title /Office col e," STATE OF FLORIDA COUNTY OF MIAMI -DADE The foregoing instrument was acknowledged before me this By C t'117 %3 fr7-r ID Individually, or ykas AtcdtviZarr.00 i C, ,t for /97 !,47/ C4' ')`t"A� 1? 7 S(440r L. ersonally known, or ❑ produced the following type of identification' Signature of Notary Public: sG e-ae Print Name: " / /el /gee N .STATE0 (SEAL) P...\ SbeUIe L. :Commission # Expires: FE BOMDAD mSUATLANTICBO irector/Partner /Manage Prepared By Print Name Title /Offic d a /Co- 7 day of M R/2_ VERIFICATION URSUANT TO SECTION 92.525. FLORIDA STATUTES Under penalties of perjury, I declare that 1 have read the foregoing and that the facts stated in it are true, to the best of my knowledge and belief. Signature(s) of Owner(s) or Owner(s)'s Authorized Officer/Director /Partner/Manager who signed above: By By 123.01 -62 PAGE 3 3110 ♦1 OR BK 276,45 PG 1132 LAST PAGE After Recording and Return to: Suffolk Construction Company, Inc. One Harvard Circle, Ste 100, Legal Dept West Palm Beach, Florida 33409 NOTICE OF COMMENCEMENT Tax Folio No. STATE OF FLORIDA COUNTY OF MIAMI -DADE The undersigned hereby gives notice that the improvements will be made to certain real property described below and in accordance with Section 713, Florida statutes, the following information is provided in this Notice of Commencement: 1. Description of the property: SEE ATTACHED EXHIBIT `A' Legal Description for the property located at 601 NE 107 Street, Miami, FL 33161 2. General description of the improvements: 107' Street Roadway Improvements — Underground electrical duct bank,. installation of a drainage and concrete paver system, electrical and landscape work. 3. Owner Information: a. Name and Address: Miami Country Day School 601 NE 107 Street Miami. Florida 33161 b. Owner's interest in the site of the improvement: Fee simple c. Fee simple title holder (if other than Owner): N/A 4. Contractor: a. Name and Address: Suffolk Construction Company, Inc. One Harvard Circle, Suite 100 West Palm Beach, Florida 33409 b. Telephone Number: (561) 832 -1616 5. Surety's name, address and phone number and bond amount: Fidelity and Deposit Company of Maryland 1400 American Lane, Tower L 19th Floor -yn,,+ ,� �G �, +p; :7- .Schaumberg, IL 60196 E Fl_�°'8��'- �T� � z�_ � P ��rGl� �y��ti i���' I NEPEI Y Crr '� t 11 "" ` eco Insurance Company of America ong Ied c._— eco Plaza o4 tile, WA 98185 `vi r �Id ..� Fiat/ �,. By Federal Insurance Company 15 Mountain View Road, PO BOX 1615 Warren, NJ 07061 Miami Shores Viiiage Building Department RECEIPT PERMIT #: 1' 1) l I �' (CO 1 DATE: I, 61..V 6 (A.C'ik1- 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ❑ Contractor ❑ Owner ❑ Ar ; itpc • 11 Address: 6)e) bAri rec scare) aO\ 1M Si From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Dept ent to continue permitting process. Acknowledged by: PERMIT CLERK INITIAL: jo RESUBMITTED DATE: PERMIT CLERK INITIAL: �DS .2,0tX.ol'1CoI Miami COUNTRY DAY SCHOOL April 4, 2011 Miami Shores Village Building Department RE: 601 NE 107th Street, Miami, FL 33161 To Whom It May Concern: Mr. John Davies, Head of School, 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. Sheltie L. Fulford Commission #DD830330 Expires: 'FEB, 28, 2013 BONDED MD ATIANTICBONDI NGea,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. Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 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. V COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. / COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) 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 (CERTIFICATE 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: Se.c_. FF0 ( k Sd- 1-..c +-A yr ( yGb-h �► -� rn c BUSINESS ADDRESS: 1 146.r 4 or: Su &c, fee CITY GDCS* Pk teac' STATE FL.. ZIP CODE 3 '161 BUSINESS PHONE: ( ) 23 Z l (0/ 6) FAX NUMBER ( () CELL PHONE ('() 1/Z 3 2-1 (9 7 QUALIFIER'S NAME: Ti °14^1 QUALIFIER'S LIC NUMBER: E -MAIL ADDRESS (IF APPLICABLE): 1Ihsp2-- nc-e— G 54 —CFol t- eo-vts-F- ,ri,,.c.4 -cam • COO-, Created on 3119109 BY MLDV 1 RV 3126109 MLDV STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 STERLING TIMOTHY WARD SUFFOLK CONSTRUCTION COMPANY INC ONE HARVARD CIRCLE SUITE 100 WEST PALM BEACH FL 33409 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants, and they keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better. For information about our services, please log onto www.myfloridalicense:cam. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn more about the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida, and congratulations on your new license! DETACH HERE (850) 487 -1395 lmv—setwwk 144P AC�f2E�® �..-- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) D4/D5�D71 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 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 Aon Risk Services Northeast, Inc. Boston MA Office One Federal Street Boston MA 02110 USA CONTACT NAME: (AIC. No. Ext): (866) 283 -7122 I FAX No.): (847) 953 -5390 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 8 INSURED Suffolk Construction Company, Inc and Suffolk Florida LLC 1 Harvard Circle west Palm Beach FL 33409 USA INSURER A: Insurance Company of the State of PA 19429 INSURER B: - Granite State Insurance Company 23809 INSURER C: American Guarantee & Liability Ins co 26247 INSURER D: X _ INSURER E: DAMAGE TO RENTED PREMISES (Ea occurrenceL INSURER F: MED EXP (Any one person) COVERAGES CERTIFICATE NUMBER: 570042090757 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADDL INSR SUBR W VD POLICY NUMBER POUCY EFF (MM/DDA'YYY) POUCY EXP (MMIDD/YYYY) LIMITS B GENERALLIABILITY GL438I5i5 08/31/2010 08/31/2011 EACH OCCURRENCE $2,000,000 X _ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrenceL $100 , 000 MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY n PEC n LOC PRODUCTS - COMP /OP AGO $4,000,000 B AUTOMOBILE LIABILITY CA 8263653 08/31/2010 08/31/2011 COMBINED SINGLE LIMB (Ea accident) $1,000,000 X X X — ANY AUTO BODILY INJURY ( Per person) ALL OWNED AUTOS HIRED AUTOS — _ X — SCHEDULED AUTOS NON -OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) C X UMBRELLA !JAB EXCESS LIAB X OCCUR CLAIMS -MADE AEC937613707 08/31/2010 08/31/2011 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 OED I IRETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N / A wC014770749 08/31/2010 08/31/2011 X I WC swap- I lam- TORY LIMBS ER Y / N ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) If describe E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 yes, under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule. I more space Is required) CERTIFICATE HOLDER CANCELLATION Holder Identifier : Certificate No : Miami shores Village Bldg Dept. Attn: Building Department 10050 NE 2nd Ave Miami Shores FL 33138 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE >_ - i+l2 ,e4 ILJ I6R6�1� ✓use ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD OILS 'Crz`riA7%;CQQ'1tr:seM1. - - -yam -' G `T F1Fi$T. .., L BUSINESS.... A)Cl.........._..'� =° >a� ,< ,•��._ -��=� `:` :..i� PO' ►t?'{'EE[ Si4 nagg sT( i4NSF Antalled9aAX:RIAIIIIIT CDOE$ *4N07: aO1ATEiAN CAE'A3T031i101:0.Tii: ANY.!. cuurfm010anmz ;.?1,000 piar.DERpontmASTHEW ':R EauiRea.Ert awaits pmrlecompuwww • h4:'u TY 4:; �iVFI' ^5kF;i }•i`,'t ' PAYFOENYR�CEIN20'<... tINIAta- nAD$,caurr lir tvgazCidstssw SEE OTHERSIDE DO NOT FORWARD SUFFOLK CONSTRUCTION COMPANY INC REX B KIRBY . 701 NW 62 AVE 450 MIAMI FL 33126 ‘„ 11,,,it,,,,it„ i,i,11 „,1„ 1,11 111„,111.,11„,1.3,11 1 9 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 BUILDING PERMIT APPLICATION FBC20 Permit T BUILDING ROOFING h p � %7 2011 Permit No. 'FLA Cf /1 Cd l Master Permit No. OWNER: Name (Fee Simple Titleholder): AC O..'. L (3u.. ":+r r Da- y SC La 1 Phone #: Address: (o C7 ( UJ E (0 9 •t" 5÷. City: All ice.: L State: Zip: 3 3/6, 1 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: (.9° t G 107 City: Miami Shores County: Miami Dade zip: 3 314 Folio/Parcei#: Is the Building Historically Designated: Yes N Flood Zone: CONTRACTOR: Company Suffolk Construction Co., Inc. P Y Name Phone #: 561 - 832 -1616 Address: 701 Waterford Way. Suite 450 City: Miami Qualifier Name: Dagoberto Diaz State Certification or Registration #: QB22305 State: Florida Zip: 33126 Phone# 305 -374 -1107 Certificate of Competency #: _ CGC1519678 Contact Phone#: 305 -374 -1107 Email Address: ddiaz @suffoikconstruction.com DESIGNER Architect/Engineer: F y5C. C) i Value of Work for this Permit: $ Square/Linear Footage of Work: Phone#: 3 - 392 `,s?z G Type of Work: °Addition Description of Work: New ORepair/Replace °Demolition y r ** ******* ***** * * * ** * ******* Fees** ** ** *** ***** * * *** ****** *ass* * *** * ** ** * Submittal e ; Permit Fee $ >- a6' CCF $ CO /CC $ Scanning T'e1 Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ P� 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.T4CTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, BEATERS, TANKS and AIR CONDITIONERS, ETC..... OWNER'S A.S'k'WAVIT: 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 conunencement 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 s The foregoing instrument was acknowledged before me this / 2 day of (, ,20 /t,by 0414 -k % / Q77J who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: •L� My Commission Expires: APPROVED BY TARP PUBLIC-STATE OF FLORIDA '''' Sheltie L. Fulford Commission #DD850330 '1/4,,,.••' Expires: FEB. 28, 2013 F Tim ATLANTIC BONDING CO,1NC. lan" s Examiner Contractor The for going ins ment wa acknowledged before me this day of 20 I , by who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: My Commission Expire, 2- BROOKE CATO MY COMMISSION #EE079911 D(PIIRES:MAAtR 31, 2015 � It 9041 nce Zoning Structural Review Clerk (Revised 07 /10/07XRevised 06/10/2009)(Revised 3/15/09) Miami COUNTRY DAY SCHOOL August 12, 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, ar042-petita. 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 THRII ATLANTIC BONDING CO.,INC. ,a6e( 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. F oe- 4.ifek 7980) AU 1/ 7 2011 TO--(001 z SUBJECT TO COMPUANCE WITH ALL FEDERAL. STATE AND COUNTY RULES AND REGULATIONS I HEREBY CERTIFY: That alt data recared in this. Field Book No , Pages 0/thru7S, is a true represefrtdtidn of the . field survey made under my direction, are is true correct to the best of my knowiege and belief. BATE: °CPO/ ZOO - r Ya�?4 -27 ARTURO R. TOIRAC PLS. 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