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MC-11-956Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 173964 Permit Number: MC -5 -11 -956 Scheduled Inspection Date: July 02, 2012 Permit Type: Mechanical - Commercial Inspection Type: Final Owner: , BARRY UNIVERSITY Work Classification: Addition /Alteration Inspector: Perez, JanPierre Job Address: 11300 NE 2 Avenue Laundry Room Miami Shores, FL 33138 -0000 Project: BARRY UNIVERSITY Contractor: GEZER CONSTRUCTION GROUP INC Phone Number Parcel Number 1121360010160 -38 Phone: (954)907 -3103 Building Department Comments INSTALLATION OF NEW AC UNIT AS PER LETTER FROM CONTRACTOR AND APPORVAL FROM THE B.O, OK TO EXTEND PERMIT 180 DAYS. q9") Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 160226. HANGER ROD OK JPP5/16/12 June 29, 2012 For Inspections please call: (305)762 -4949 Page 15 of 38 Miami Shores Village Building Department 1 0050 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 FBC 20 Permit Type: MECHANICAL Permit No. C I 1 615(6) Master Permit No. CC- 1 t l S2) Phone#: 503"—.39? '349/ OWNER: Name (Fee Simple Titleholder): O/ Address: %i f City: ail i J t J State: Tenant/Lessee Name: Zip: 3 3107 Phone#: Email: JOB ADDRESS: ifreidtoen. City: Miami Shores ( County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes CONTRACTOR: Company Name: Address: c2...1 City: P42 vit Qualifier Name: - k – J State Certification or Registration #: Contact Phone#: DESIGNER: ArchitectlEngineer: NO Flood Zone: Phone#: ?9i O ® � L 122..2." —e�Luso State: ... Zip: 3-s ®6 j Phone#: '7511 c M C 12ii Ty. 1 1, Certificate of Competency #: Email Address: Phone#: Value of Work for this Permit: $ 6r 100 . O Square/Linear Footage of Work: ew epair/Replace °Demolition Type of Work: °Address Description of Work: °Alteration ,v C74 * * * * * * * * ** *** * * * * *a**** * *a*s ****** * ** ** ***** ** Submittal Fee $ Permit Fee $ 1 n' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ n I` 1-1 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 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved jiadja reinspection fee will be charged. Signature Owner or Agent 1(�Lh The foregoing instrument was acknowledged before me this nt L day of W )k T , 20 i , by ao406 �1J iY� , who is personally known to n je or who has produced As identification and who did take an oath. NOTARY PUBLIC: Signature Contractor The foregoing ins �,_._ t was acknowledged before me this day of 20 IL, by d "TCo. -(c S�� e .'— 1,1 who *person y known( me or who has produced as identification and who did take an oath. NOTARY PUBLIC: APPROVED BY Structural Review (Revised 07 /10/07)(Revised 06/10/2009HRevised 3/15H09) Sign: Print: My Commission �otaR;,;�e4 SEROUS KAZAKOV MY COMMISSION+ *EE003459 EXPIRES: October 2S, 2014 4/0,,,, Bonded TM' Budget Noy services Zoning Clerk Ac# 5044295. STATE OFFLORIDA �gggxx DEPARTMf sTRU8RMADMRYRLZCEN5IN L$ ©ARD TION'. SEQ#L10071901005 DATE BATCH NUMBER ,01 19 2010 108010641 I EWE NER The MECHANICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS.. Expiration date: AUG 31, 2012 ALERSEJ GEZER CONSTRUCTION GROUP INC 627 E. ATLANTIC BLVD. 12 -229 POMPANO BEACH FL 33060 CHARLIE CRIST GOVERNOR DISPLAY AS REQUIRED BY. LAW CHARLIE LIEN INTERIM SECRETARY. R ; - S +1Ta1 •a1- 1.'..'7�- •f >< °•� lane ti `111[:VI,Tl.7"••i`+• t:: Jf -f ii.'7.1 -.■ 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301 -1895 — 954 -831 -4000 VALID OCTOBER 1, 2010 THROUGH SEPTEMBER 30, 2011 Business Name:GEZER CONSTRUCTION GROUP INC Owner Name: Ar EILEF. T BEREZNOJ Business Location: 627 E ATLANTIC BLVD #12 - 229 POMPANO BEACH Business Phone: 954-907-3103 Rooms Seats Employees 1 Receipt/P.183-1945 Business Type:KRA (MECHANICAL CCONTTRRACTORR)) Business Opened:o6 /18/2009 StateiCountylCertlReg:CML1249878 Exemption Code:NONEx mPT Machines Professionals For Vending Business Only • _ Tax Amount flmuIJu, WI ,[,OM,l Transfer Fee fl a. NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT Ns tax is levied for the privilege of doing business within Broward County and is non- regulatory In nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business Is legal or that it is in compliance wlltil State or local taws and regulations. WHEN VALIDATED Mailing Address: ALEKSEJ BEREZNOJ 627 E ATLANTIC BLVD #12 -229 POMPANO BEACH, FL 33060 2010 - 2011 Receipt 013A -09- 00009313 Paid 08/10/2010 27.00 &R b® CERTIFICATE OF LIABILITY INSURANCE OP ID AM GEZER -1 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. DATE (MMIDDIYYYY) 05/18/11 PRODUCER W.F Roemer Insurance Agency William F. Dowd P.O. Box 190669 Fort Lauderdale FL 33319 Phone:954- 731 -5566 Fax:954- 731 -8438 INSURERS AFFORDING COVERAGE NAIC # INSURED Gezer Construction Group, Inc. 627 E. Atlantic Blvd. 12-229 Pompano Beach FL 33060 INSURER A: Vinings Insurance Company INSURER B: Mid- Continent Casualty Co 23418 INSURER C: INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR VTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMNDD/YYYY) POLICY EXPIRATION DATE (MMIDDIYYYY) LIMITS B GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY 04GL000787976 01/12/11 01/12/12 EACH OCCURRENCE $ 1,000,000 X PR MISES(Ea�occurence) $ 100,000 CLAIMS MADE OCCUR MED EXP (Any one person) $ EXCLUDED PERSONAL & ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER —I PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY la l jECT n LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGELWBH.RY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? ECUrnrD (Mandatory In NH) If SPECIALd PROVISIONS below WCV007 224201 09/18/10 09/18/11 WC S I ATU- OTH- TORY LIMITS ER E.L EACH ACCIDENT $ 1000000 E.L DISEASE - EA EMPLOYEE $ 1000000 E.L DISEASE - POLICY LIMIT $ 1000000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 NE 2nd Ave Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2009/01) AUTHORIZED REPRESENTATIVE _ Q� ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD