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ELC-12-361Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL / �, Phone: (305)795 -2204 Fax: (305)756 -8972 '\ C� 3g Inspection Number: INSP - 170614 Permit Number: ELC -3 -12 -361 Scheduled Inspection Date: March 14, 2012 Inspector: Devaney, Michael Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Wiegand & Annex Miami Shores, FL 33138 -0000 Project: BARRY UNIVERSITY Contractor: BLUE WAVE COMMUNICATIONS Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360010160 -09 Phone: (305)436 -8886 Building Department Comments LOW VOLTAGE DATA & VOICE CABLE WEIGAND CENTER RM 253 NURSING SIM LAB Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments March 13, 2012 For Inspections please call: (305)762 -4949 Page 18 of 27 ZIl2 -u1 BUILDING PERMIT APPLICATION Fsc zo 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. ELC12 361 Master Permit No. I 1 — ( U 5¢ Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): � y uN 1 Vim( t Y Phone#: Address: 11 ZOO I t.G nv City: m 1 A t t Sl 0'161 State: � `, Zip: 331 C 1 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS:1 (A/146PN (46i 44/0b eraira Eu Zug loutglikt cipt, LAS City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 'Zkl,k WOE' eaUL O )1 OATI 0001 Phone#: J -RW0 Address: Z Sig k ] 7+-+1 �e0600 itteseut,,1 J'(' - Z- 1.7/x"5 City: C. State: - G,L Zip: g 31 7■, Z, Qualifier Name: 11 .01(5i1--`/ bet, Phone#: ° gia - State Certification or Registration #: I 1.0056g6 y Certificate of Competency #: Contact Phone #: 5:1(-15(31b , `Q fS Email Address: .,11L & 6. ] - e11i iA it ZOU DESIGNER: Architect/Engineer: Phone #: _ Value of Work for this Permit: $ JSds 5 inear F e of Work: Type of Work: ❑Address DAlteration epair/Replace ODemolition Description of Work: **** ** *+ r******* *************** * *** *****F ******+ *** ******** * *** ********** **m*+x******* Submittal Fee $ Permit Fee $ / f r 4'47 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ I • CI 0 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 ECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing informalion'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 commenceme Must be d at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the posted notice, the inspection will not be approved ;bor. einspection fee will be charged Signature Owner or Agent The foregoing instrument was acknowledged before me this 2- day of f -- , 20.12 -, by —11Aid C- '. who i Contractor The foregoing instrument was acknowledged before me this 2Vi day of WANLY , 20 ,�,, by arbocr, taDwiraar who is personally known to me or who has produced • As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: 4- My Commission ** *** * * **r8** * * *** * *** *** 8r APPROVED BY onally known me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Co pi£g'IR,cr `/t ` (407) 398-0153 FlorldallotaryService.corh '6S 8 *** **rkrNAr*+k****drrkrk**rk*%k> Kok*** ***rk**+ k**rN****rk+ k****rkrkrk+ krk+ krk*rkrNrk*NrrbrN**rkrH*rkrRrkrk >N*rk**>K** A/A - Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) 9R °� CERTIFICATE OF LIABILITY INSURANCE DAM; IVDD/Y2Y) 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(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 Seitlin, A Marsh&McLeanan Agency LLC Co. 6700 N. Andrews Ave. Suite 300 Fort Lauderdale FL 33309 CONTACT PHONE FAX (AIC.No.Extl: (954) 938 -8788 (AIC.No):(954) 938 -8566 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Phoenix Insurance Company 25623 INSURED Blue Wave Communications, Inc. 2898 NW 79th Avenue Doral FL 33122 INSURERB:Charter Oak Fire Insurance Co. 25615 INSURER C : 1/28/2013 INSURERD: $ 1,000,000 INSURERE: $ 250,000 INSURER F : COVERAGES CERTIFICATE NUMBER: Cart ID 31573 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 TYPE OF INSURANCE ADDL INSR SUBR MD D POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY E XP (MMIDD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY ZLP- 14P1415A -12 -I3 1/28/2012 1/28/2013 EACH OCCURRENCE $ 1,000,000 pREMSES(Eaaocxwrrrence) $ 250,000 CLAIMS -MADE X OCCUR MED EXP (My one person) $ 10, 000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES POLICY n JECT PER: LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS NON -OWNED AUTOS BA321M7711 1/28/2012 1/28/2013 C COMBINED SINGLE LIMIT 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE ZLP- 14P1415A -12 -23 1/28/2012 1/28/2013 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ DED X RETENTION 10,000 A WORKERS COMPENSATION AND EMPLOYERS' UABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A BDTDNUB8159C77012 1/1/2012 1/1/2013 % WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L DISEASE - EA EMPLOYEE $ 1,000,000 E.L DISEASE - POLICY LIMIT $ 1, 000,000 A Cyber E &O Retro Date: 4/3/04 7805800531 1/28/2012 1/28/2013 Each Wrongful Act/ $ 1,000,000 Total Limit Deductible $ 10,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Proof of insurance only. CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores FL 33138 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 S *,1Y +,.-K+ ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD E,COUNTY 2011 567224-2 BUSINESS NAME / LOCATION BLUE WAVE COMMUNICATIONS INC 8399 NW 30 TERR 33122 DORAL AMI -DAD EXl, MUST'BE ISPLAYL. PURSUANT TO COUNTY fI THIS IS NOT A BILL OWNER BLUE WAVE COMMUNICATIONS INC Sec. Type of Business 196 SPEC 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 CITIES. 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 -DADS COUNTY TAX COLLECTOR: 07/18/2011 60040000761 000045.00 SEE OTHER SIDE RECEIPT - STATE OF FLORIDA EPT. 30, 20'12 AT PLACE OF BUSINESS x D CHAPTER 8A FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 — DO NOT PAY RENEWAL RECEIPT NO. 591634-2 STATE* ES12000536 WORKER /S 4 DO NOT FORWARD BLUE WAVE COMMUNICATIONS INC ALBERTO DOSAL PRES 8399 NW 30 TERR DORAL FL 33122 III IIIII1I1I11111111Fil1'I /11inII 11.1 11111h Ali Ii MICRO PRINT SIGNATURE LINE SHOWS UP UNDER`MAGNIFI"CATION ARTIFICIAL WATERMARK SCREENED ONTO BACK OF DOCUMENT 2