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DEMO-12-1194Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 175260 Permit Number: DEMO -6 -12 -1194 Scheduled Inspection Date: July 19, 2012 Inspector: Bruhn, Norman Owner: CHURCH, Job Address: 602 NE 96 Street Miami Shores, FL Project: <NONE> Contractor: QUIRINO CONSTRUCTION CO Permit Type: Demolition Inspection Type: Final Work Classification: Phone Number (305)754 -9541 Parcel Number 1132060141410 Phone: (305)892 -1987 Building Department Comments REMOVAL OF 16' PARTITION WALL BETWEEN CLASSROOM #112 & #113 Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments July 18, 2012 For Inspections please call: (305)762.4949 Page 20 of 27 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 BL7IL'DING PERMIT APPLICATION Permit Type: BUILDING JOB ADDRESS: b 02 ALE 14 5tg E Er �� itl, t V, e- i rF�BCp 20 Permit No. t; :,h-U 12 ref" Master Permit No. ROOFING City: Miami Shores County: Miami Dade Folio/Parcel #: 11* 3204. . 014 • 1410 Is the Building Historically Designated: Yes NO ✓ Flood Zone:® Zip: $3138 41'/ OWNER: Name (Fee Simple Titleholder): MUM f ilm s 9*E$ /Tt'Q ibl (RdRt one #: Address: 402 NI. q�i 5T' City: WW1 $W4,& 5 State: _ FLDRI DA Tenant/Lessee Name: — Phone #: Zip: 33(35 47 Email: CONTRACTOR: Company Name: II/ ('A'TROCTie& CO Phone #: '" MP tW 04 Address: 1 197 N.E 1I _ Q ,D City: it/elkf#4 14 /A I A /41 State: FLORIDA Zip: 33121 Qualifier Name: ..10/4/U a - goal A!O Phone #: 305 eta 19g7 State Certification or Registration #: G 0 3 i iF 6 G Certificate of Competency #: Contact Phone #: 3O5 t 93. `11 f7 Email Address: DESIGNER: Architect/Engineer: "' Phone #: Value of Work for this Permit: $ ?8.5 Square/Linear Footage of Work: 14A #1 Type of Work: ❑Addition ❑Alteration ❑New ❑Repair/Replace IVemolition Description of Work: pp i u9'6, F /Z 17 n t9 ; % ivs EN 6.44 S$ goo if #. X13 Color thru tile: Submittal Fee $ Permit Fee $ /a CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City D 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 m 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 :. ,Asa 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 Agen The foregoing instrument was acknowledged before me this o2a The foregoing instrument was acknowledged before me this oZ day of Q / , e . 4 e L . . „ 20 ( , by , day of te4e-- ¢.!'20 /•2., by v o is sonally known to me r who has produced ho is per6nally known to m�or who has produced A C ntractor As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: l/�fsic on Ex fires: My Commission APPROVED BY NOTARY PUBLIC -STATE OF FLORIDA s° "' - Sylvia Halter ' = Commission # EE098053 •,..,,,,s Expires: JUNE 08, 2015 •` Expires: JUNE 08, 2015 **** ::�:�:� *�cN AA MWM ,, Arles * ** *** : * ** : ** ::* : * *: x * *: * *aslM Yemme 2N iC�f.;'tl , as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: NOTARY PUBLIC -STATE OF FLORIDA Sylvia Halter = Commission # EE098053 Plans Examiner Zoning Structural Review Clerk (Revised 5 /2 /2012XRevised 3 /12 /2012XRevised 07 /10 /07XRevised 06 /10 /2009)(Revised 3/15/09) 1 E. cu. v E 1I RE/A0VAL OF BETNI/E-F-R----cui:55-noz 1)2 1 *11.3 '2-11 Miami Shores Village APPROVED BY DATE ZONING DEPT 1:51:Sirkg_E)-- PtOftAi jaI SUBJECT TO C;OMPLIANCE WITH ALL FEDERAL STATE AND COt /NTY RULES AND REGULATIONS /141414101 6-28-I2 &MT, v 6 Ct-ZS-R0011_\_It_ Pzifirloc 11 REJACta EYIST1 N6. PA-1411)mA x 61- 8" 5r0 P5 IjitIWALE 1 I rZEMIZ,_,..11:a0S__Tit_z_c_t 61 1 II Roog 1 AVA.1.L.6 f A p (LA55Ropilv- riasr N6 Ert.s-rog n-TE • ELE CT rZILIY__ OR. 01:07ABTR-G- 04 \vat QUIRT -1 OP ID: BH °`,�C.". R° CERTIFICATE OF LIABILITY INSURANCE �` 05/14f12 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: it the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION 15 WANED, 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). W.F. P Roemer Insurance Agency 954-731-5566 4752 W. Commercial Blvd 954- 731 -8438 Fort Lauderdale, FL 33319 William F. Dowd O P FAX ,�, INC, NO); ADDRESS: INSURERS) AFFORDING COVERAGE NAIL 0 INSURER A : Mid - Continent Casualty Co INSURER B: 23418 INSURED Quirino Construction Co 1987 NE 119 Road North Miami, FL 33181 INSURER C : INSURER 0 : CLAMIS -MADE C OCCUR INSURER E $ Excluded INSURER F : dr. • N,VII IW IR0I_,\• THIS IS TO CERTIFY THAT THE POUCIES 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. ILL B TYPE OF INSURANCE INCR - ywp POLICY NUMBER 04GL000848725 (MMIDDIYYYY{ 05111/12 (MMIDC 05111/13 LIMRS EACH OCCURRENCE $ 1,000,000 GENERAL X I lam ITT COMMERCIAL GENERAL LIABILITY pDRAZEREaRENTED n e) $ 100,000 CLAMIS -MADE C OCCUR MED EXP (My one person) $ Excluded PERSONAL & AOV INJURY $ 1,000,000 GENERAL AGGREGATE $ Z000,000 GENI AGGREGATE LIMIT APPLIES PER: —I POLICY Ip CT I 1 LOC n PRODUCTS - COMPIOP AGG $ 2,000,000 $ AUTOMOBILE — _ -- UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS °— SCHEDULED AUTOS AUT S� COMBINED SINGLE LIMIT (Ea accident) 1 $ SODILY INJURY (Per person) $ BODILY INJURY (Per aeadent) $ {PPera nt) AGE $ UMBRELLA LIAR EXCESS LIAS r OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED 1 I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y 1N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERMEMSER EXCLUDED? n (Mandatory in NIT) If yes describe under DESCRIPTION OF OPERATIONS below N 1 A WC STATU- I TOTH- TORY LIMITS f I ER EL. EACH ACCIDENT $ E.L. DISEASE - M EMPLOYEE $ E.L DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LDCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule It more space Is required) Subject to policy terms and conditions. CCQTICI•ATC u/1a mme. MIAMIS2 Village of Miami Shores 10050 NE 2 Avenue Miami Shores, FL 33138 VPN0VCL1." 1 IVIY SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE � _ 41� ACORD 25 (2010105) C�? 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD .r ACORCP CERTIFICATE OF LIABILITY INSURANCE `....• --- DATE (IAMIDDIYYYY) 11/22/2011 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 POUCIES 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(les) 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 W F ROEMER INS PO BOX 190669 TAMARAC FL 33319 CONTACT PHONE FAX RUC. No. Ext): (954)731 -5BAR A/C. No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A: FWCJUA GENERAL INSURED QUIRINO CONSTRUCTION CO INC 1987 NE 119TH ROAD NORTH MIAMI FL 33181 FEIN: 596172614 INSURERS: $ INSURER C : $ INSURER D . INSURERS: NSURERF: PERSONAL & ADV INJURY CERTIFICATE NUMBER:201111917 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POUCY NUMBER c•EMM/DD/YYYY) , , • POLICY EFF • '• POLICY EXP (MMIDD/YYYY) • LIMITS EACH OCCURRENCE $ 1 GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ MED EXP, (Any one person) $ CLAIMS MADE OCCUR PERSONAL & ADV INJURY $ ' GENERAL AGGREGATE $ '• PRODUCTS - COMP /OP AGG $ GENT. AGGREGATE POLICY LIMIT APPLIES . JECT PER LOC $ AUTOMOBILE — _AUTOS LIABILITY ANY AUTO ALL OWNED HIRED AUTOS — _ _AUTOS •` .,a SCHEDULED AUTOS NON -OWNED CO (Ea E�DUSINGLE LIMIT $ BODILY INJURY' (Per person) • $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ A WORKERS AND ANY OFFICE/MEMBER (Mandatory If yes. DESCRIPTION CO EMPLOYERS' PROPRIETOR/PARTNER/EXECUTIVE In NH) describe under OF ENSATION LIABILITY EXCLUDED? OPERATIONS below ' Y f N �{ I T - I 11i NIA C 9607L30A MINIMUM PREMIUM POLICY 11/7/2011 11/7/2012 l WC STATU• OTH- X 1 TORY LIMITS I I ER E.L. EACH ACCIDENT $ 100,000,00 $ 100,000.00 EL. DISEASE • EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ 500,000.00 a■ DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) " R• CERTIFICATE HOLDER CANCELLATION Village of Miami Shores Building Departrrlent 10050 NE 2nd Avenue Miami Shores PhoneNumber o FL 000 -000 -0000 A 33136 , SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ^ AUTHORIZED REPRESENTATIVE C1 47g��,� ACORD 25 (2010/05) II) 1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 QUIRINO, JOHN ANTHONY QUIRINO CONSTRUCTION COMPANY 1987 NE 119 RD NORTH MIAMI FL 33181 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.com. 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 STATE OF FLORIDA AC# DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CGC031466 06/15/10 097060187 CERTIFIED, GENERAL CONTRACTOR QUIRINO, JOHN ANTHONY QUIRINO . CONSTRUCTION COMPANY IS CERTIFIED under the provisions of Ch.489 FS Expiration date; ADO' :`.31,. 2012 L10 0 6 15 010 5 5 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROF SSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING 'BOARD L1006150105 DATE BATCH NUMBER LICENSE NBR 06/15/2010 097060187 CGC031466 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2012 QUIRINO, JOHN ANTHONY QUIRINO CONSTRUCTION COMPANY 1987 ;NE 119 RD NORTH 'MIAMI, FL 33181 CHARLIE :GRIST GOVERNOR DISPLAY AS REQUIRED BY LAW CHARLIE LIEM INTERIM SECRETARY