Loading...
CC-12-1443Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 176893 Permit Number: PLC -8 -12 -1474 Scheduled Inspection Date: August 24, 2012 Inspector: Hernandez, Rafael Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Dalton Hall Miami Shores, FL 33138 -0000 Project: BARRY UNIVERSITY Contractor: JOHN JONES PLUMBING SPECIALIST INC Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360010160 -17 Phone: (954)966 -6834 Building Department Comments DISCONNECT 3 SINKS AND CONNECT 3 SINKS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments August 23, 2012 For Inspections please call: (305)762 -4949 Page 10 of 13 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 BU DING PERMIT APPLICATION BY: o ® ® ®oo ®m ®m ®oe ® ®m ®oo Master Permit No. Permit Type: PLUMBING JOB ADDRESS: t3. ak-Y uitk► d v qty — bb L6 t 1 Z4 AV G . MIA( FL) City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated; Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Bk,V Phone#: Address: 1 300 N6 TA4 AVG City: N AA 1 O State: Zip: 3 3lid) Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: IA n. O e.) P .,40 J Lye aet�!,i&4 Phone#: I VAG& -68/3 Address: c ) . ell . X1770L City: Y'`' l fW Ufl State: f J O t- Qualifier Name: k A Deli State Certification or Registration #: C. L CtO1 Contact Phone#: Email Address: zip :330k / Phone #: °I i —11,&.- &'i9 Certificate of Competency #: C FL c)57 5 C 7 DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ ` o a a Square/Linear Foo ork: w e air/Re lace Type of Work: Address °Alteration Description of Work: NA A e ov4v,°4-• k S �.0 w° . J .. Ceeiii e , S't'` .5 ONe p p °Demolition * ***** * *** ** ** *** *** * * **** *** ** * * ** *mss* *, x*********** ******** ** *** * * *** **** * * * ***** Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ t I 4 r D Bonding Company's Name (if applicable) N 1A- Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) 0 Pe 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 MR 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 y' a reinspection fee will be charged. oar Signature Signature . ■ Owner or Agent M Contractor 441 The foregoing instrument was acknowledged before me this The foregoing instrume I was acknowledged before me this 2Y day of /115,41- , 20 by RAM who is personally known to me or who has produced 1'%l k As identification and who did take an oath. NOTARY PUBLIC: Sign: I/ Print: . AN the /(1 Pw,6 pA Kam FARZ- y C01�M1SS $ My Commission Expires: *i * EXPIRE!: Awe! 19, 2613 I> �t� Bnlerlln+ Wry Bolus day of Al1Gpvd— , 20 %? , by P41 who is personally known to me or who has produced 1%))/* as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: ° My Commission Expires: ' ••• " IOWA FARnal. BD0681239 MYtONM�ISSION EXPIRES: MMwt -1L, 2613 AO' Berried Ito Budget Wins *****a•**** ******** **** � ****x�s•a��x****a *** �a�x�•,ua�****�x**** >e+xs=�x**** +�x•�x�x+es•�x� ** * *+x ********'************ * ****a APPROVED BY e 4 �` Plans Examiner Zoning Structural Review Clerk (Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15109) Miami Shores Village 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. 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: John 704 ci FJ4 � inc. - BUSINESS ADDRESS: f.', L7° iS1 ?7OV CITY 1itAVE, �I' STA TE ZIP CODE 33 o k J BUSINESS PHONE: (qS`I ) 716 -1O ' 1 FAX NUMBER (9 ) a 3 9- `S7.53 CELL PHONE ( 9S'1 ) 9& V r'� Y5 y QUALIFIER'S NAME: ) Oiin TOV e QUALIFIER'S LIC NUMBER: C F (. O S 1 Pp-7 E -MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV 1 RV 3126109 MLDV ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) 08/01/2012 PRODUCER McTaggart Insurance Agency, Inc 9050 Pines Boulevard #415 Pembroke Pines, FI. 33024 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 NAIL INSURED John Jones Plumbing Specialist Inc PO Box 817706 Hollywood, FI. 33081 INSURER A: American Vehicle INSURER B: Normandy Harbor 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 INSRD TYPE OF INSURANCE POUCY NUMBER p�6 ��yE alkR EIFIA PORN DATE r(M N N LIMITS A GENERAL Z. GEN'L 71 LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE V OCCUR GL 0000012970 08/01/12 08/01/13 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 100,000 GENERAL AGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER: POLICY n PROJECT n LOC PRODUCTS - COMP/OP AGG $ 2,000,000 AUTOMOBILE J UABILITY ANYAUTO ALL OWNED AUTOS SCHEDULED AUTOS AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY person) (Per $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE UABILITY ANY AUTO 7 AUTO ONLY - EAACCIDENT $ OTHER THAN EAACC S AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY OCCUR CLAIMS MADE DEDUCTIBLE 7 RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ $ B WORKERSCOMPENSATIONAND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? If es, describe under SPECIAL PROVISIONS below NHFL 110386 08/01/12 08/01/13 �/1 TORYLIMITS n ER E.L. EACH ACCIDENT $ 100,000 E.L DISEASE - EA EMPLOYEE $ 100,000 E.L DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERAI IONS 1 LOCAUONS 1 VEHICLES / <:XCLUSIONS ADDtD BY ENDORSE EN r / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION I City of Miami Shores 10050 NE 2ND Avenue Miami Shores, FI. 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 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 PRESENTATIVES. ALIT ORIZED REPRESENTAT ,.. 404 t v// et ACORD 25 (2001/08) © ACORD CORPORATION 1988 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VAUD OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: Business Name: JOHN JONES PLUMBING Owner Name: JOHN JONES Business Location: 2430 SHERMAN STREET HOLLYWOOD Business Phone: 954- 966 - 6834 Rooms Seats ReCetpt #:18 2 -1328 SPECIALIST INC Business Typet (PLUA� NGLWNNSPRNI L/ ONT Business Opened:09/22/2005 State/Cou my /Cert/Reg: 7 7 CMP14 9X/ CFC0 5 7 5 6 7 Exemption Code:NONEXEMPT Employees 10 Machines Professionals For Vending Business Only Number of Machines:. Vending Type: Tax Amount Transfer Fee 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 This 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 with State or local taws and regulations. WHEN VALIDATED Mailing Address: JOHN JONES P 0 BOX 817706 HOLLYWOOD, FL 33081 2011 - 2012 Receipt #01A- 10- 00011140. Paid 09/15/2011 27.00 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 JONES, JOHN JOHN JONES PLUMBING SPECIALIST INC P 0 BOX 817706 HOLLYWOOD FL 33081 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 tog onto www.mridalicense.com. There you can find more Information about our divisions and the regulations that impact you, subscribe to department newsletters and loam 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 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 176566 Permit Number: CC -7 -12 -1443 Scheduled Inspection Date: August 24, 2012 Permit Type: Commercial Construction Inspector: Bruhn, Norman Inspection Type: Final Owner: , BARRY UNIVERSITY Work Classification: Repair Job Address: 11300 NE 2 Avenue Dalton Hall Miami Shores, FL 33138 -0000 Project: BARRY UNIVERSITY Contractor: BELFOR USA GROUP INC Phone Number Parcel Number 1121360010160 -17 Phone: (954)275 -1977 Building Department Comments REPAIR AND REPLACE DAMAGE FLOORS AND WALLS DALTON ROOMS: 108 -100 AND 208 -200 LAUNDRY AND STORAGE ROOMS Inspector Comments Passed c Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. August 23, 2012 For Inspections please call: (305)762 -4949 Page 8 of 13 DING PERMIT APPLICATION FBC 2,(K Permit Tvoe 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) 7624949 ECEIIVE JUL 3.1 Z Permit No. Master Permit No. CO1 19H 3 OWNER: Name (Fee Simple Titleholder): 5R Z( U N1U S1i(� >ftLp-bt�( Phone#: 3o5 - ' 5 Cb �. Address: 1 � �� %(� `�N � �-� � City: iiAM, State : Zip: 33 ( Tenant/Le Name: a ;: t Email: i � &Me#, JOB ADDRESS: �'` jA� apr s5 City: Miami Shores Folio/Parcel#:- tc -ro d' County: Miami Dade Zip: Is the BOiding l istori<allyI1esignated :Yes NO l�Lone: . . CONTRACTOR: Company Name: REt -- u5A Address: (' 20 S', City: 'A Phone: q✓q%jgla -''? State: _. CA-1,4 MCa�US �P: 3Z Qualifier Name Phone #• (75Y-,9% - '9 State Certiteatien or'ltegistratien'# ` c--66: 4 `5 7Cl r certificate 4tom Contact Phone#: - (n9 t 60/4 Email Address: S'he1 ear so-uS , e rz. 0-.0/ DESIGNER 'Arclutect/Engrneeri Phone*: Value of Work for this Permit: $ 3 a r 0 Square/Linear Footage of Work: �(/ t' '' Type of Work: °Address °Alteration ONew Ill epair/Replace °Demolition Description of Work: RP PAWL. is Ply f7 P EPLAC. x NAM Ploart.s W m- thl (2.) y- til-i-rox Poo KS 08 ., -'I0(5 616 i l u 1*-y, Pain s ')(some -,t2 406 a ; 6 (Lvrw Pr cte 144 oNI>LNIgooptsY s°a.a cE o4s) . . * * * * * * * * * * *.► w* +h_ *a***w4,* w* ws' F * *Is*** *A * * * *r * * *a * * * * ** *** * * **** * *** Submittal Fee $_�— Permit Fee $ �" F CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Training/Education Fee $ Technology Fee $ g..7.-P0-1-5- 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 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, PJ.UMB1NG, 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 conmencement 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 bd proved and a reinspectionJee will be charged. Signature Owner or Agent _ The foregoing instrument was acknowledged before me this �� day of a)�1 ,20 by MI4AC c. lLif+tl who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: d IA ).. Print: r! maw Signature Contractor The foregoing instrument was acknowledged before me this day of Ttk I , 20,.,by Sett .414,e,lCS who i. personally kno to me or who has prod}tcec1,, as identification and who did take an oath. NOTARY PUBLIC: „t AY f>e,:1„ Ki � mberly Stahl Sign: ,~ ~jl; CA1dMIS I7 WEE 169884 Print ,ire') EXPIRES: FEB. 15, 2016 °,6�,.. 0`� WWW.AARONNOTARY.com My Commission Expires: * * * * * *, ********************,********** * * * * * * * *** * * * * * * * * * * * * * * * * * * * ** ******* * * * * * * ** * * * *** * * * * ** * * * * * ** * * ** APPROVED BY Plans Examiner Structural Review (Revised 07 /10107)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 11 1 1 1 1 1 1 1 1 11 1 1 1 1 1 11 1111 1111 NOTICE OF CO ENCEMENT A RECORDED copy MUST BE POSTED ON THE MB SITEAT T1M.E OF Mr INSPECTION PERM' NO. e<1.— rbuo STATE OF FLORIDA'. COUNTY OF MIAMI-DADE: THE UNDERSIONED iterePy gives poticelhat improvements will be made to certain real property, and in aecordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Canmancernent. 1. Legal desert • of . . petty and street/address: RA IL R-y UQN IV efici rY iokA 1 _ 2. Description of mprov CFN 2012R0536833 DR Bk 28209 Ps 2673; (1ps) RECORDED 07/31/2012 115433 HARVEf RUVINr CLERK OF COURT MIAMI-DADE COUNTY, FLORIDA LAST PAGE Space abort reserved tef recording office fl 3c) A06 I, AWL% .M.1111111111k 3.. -70witilitS) mine-end a ress: _ Interest in property: Narnt!Pri0 address of fee SIMPie ligeholder: 4. Co ctor's name, ad and phone number: 1,1 . • —1/ eer. , monnetimimiem-ittwramma 5. SuretT (Payment bond ' T. by Owner from oontroaor, If MATE OF FLORIDA, CouNr( oF DADE Name, address and phone number: . * /I th Amount Of bond $ Lender' name and address WI! fiked if it :silt ., Statutes 7. Persons within the State of Florida designated Owner oPo Section 71a13(1)(a)7 frivrn, may Name, address and Phone nUmber: • ••';MIIIIEVILIN.-.;•_ _••■••■•••.' • : I 8. In additkin'tohimielt OWneis designates the folloWing 713.130* Florida StatUtel. Name,. address and hone number: n(s) recel copy of the Liehor's Notice ftS provided in Section , 9. ExpirtttiOn date of this Notice of Commencement (the eipIration date Is 1 jieirfroni the date Of recording Weis a different date Is tgrcIfled) IffARNINAVO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE bspIRATIONOF THE NOTICE OF COIVIMENOENIENT AFIE OONSIbERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1. SECTION 713.13. 'FILORIDA STATUTES; AND CAN RE-bar IN YOURPAYING TWICE FOR IMPROVEMENTS TO .YOUR PROPER1Y. A NOTICE OF COMMENCEMENT MUST BE AND POSTED ON THE flItTINSPEdTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR ANATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEmENT. Signetuze(s). Prepared B • . 111,,i 7, 1" iiittai, i _ -ec! otkorprectoripartneamanager ., ,, „-- Prepared By C..41' - i '1,..?' a.eliff/-"v . Mit Name Print Name Trtle/Offibiti - V ...c. ' Vei, • C457j- • , TOgctiflOe . . =TV& FLORIDA. COUNTY OF rtiliAM;OADE Thiferyweiniti instrument was acknowledged before me this 3 IQ; day of By Mr 't. W-as , Perion* known, or u tatOWingfype of idenftificaor " Slgiiature of Notary C. I 0. Under penalties' bf PerjUiy,1 &blare that 1 have that the facts stated in it are true, to the best of .11 • 9 Signattrre(s) By 123.01-62 PAGE 3 St10 v uthorted Of8cer/Director/Partner/Manager who signed above: By DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION MOLD - RELATED SERVICES LICENSING PROGRAM (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 MORALES, SAMUEL ROLANDO 6740 NW 22 STREET MARGATE FL 33063 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.mvfloridalicense.com. There you can find more information about our divisions and the regutations 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! • 11404 ; : do ova 3,1437411•0 • • .,M•r.• »s ,,.. RTIFiE9: tf _ r'' • :' r; '1• ti id 41,44 at.oa eater', i, 2O11' z. tag 5b 1 4 i, tom' ? '� , e1i •„ko A\ ijj,` 'l. o.' THIS DOCUMENT HAS A COL.OREO BACKGROUND • T11CROPRINTJNC •LINEh1A13Kr' PATENTED PAPER DATE:'. BATCH NUMBER II 37; DATE BATCi 1 NUMBE.R !lb! e:017.117 : 41; tt:" ..• t., ••• • 1: le 6° • $S. I* 4. 0 •••• :•• " • .• .: • al, telt, ••• . elT.Ebt 'LAWS-ON,. SECRETARY. • • • • DATE DATCFI 'NUMBER • rz. • e. ;VI I t I .1 • - • `3Co. AT'i a Miami Shores Viiiage Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 RECEIPT PERMIT #: C� /1, 2..-1 44 DATE: A. 1, aowDAL0\ Contractor 0 Owner O Architect ��p Pi • up 2 sets of plans an. er) O c�0' ,( l Address: From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Department to continue permitting process. Acknowledged by: PERMIT CLERK INITIAL: RESUBMITTED DATE: l (l ct PERMIT CLERK INITIAL: l ICd T � , � cutd 08/01/2012 09:40 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES el001 ********************* **$ TX REPORT *** ********************* TRANSMISSION OK TX/RX NO 2805 RECIPIENT ADDRESS 919545965155 DESTINATION ID ST. TIME 08/01 09:40 TIME USE 00'18 PAGES SENT 1 RESULT OK Permit No: 12-1443 Job Name: August 1, 2012 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Building Critique Sheet 1) Provide approval from Miami Dade County DERM. 2) Provide plans prepared by a licensed architect or engineerwith a detailed scope of work FBC 107 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. Norman Bruhn CBO 305-762-4859 Permit No: 12 -1443 Job Name: August 1, 2012 Miami Shores Village Building Department Building Critique Sheet 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 1) Provide approval from Miami Dade County DERM. 2) Provide plans prepared by a licensed architect or engineerwith a detailed scope of work FBC 107 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. Norman Bruhn CBO 305 - 762 -4859 43i--9(49 _51Ss 8/16/2012 3:05:22 PM Faxserver 847 - 953 -5390 Page 3 ,,,,xj,c'yE"]rf.r.b° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/16/2012 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 Aon R sk Ser vi ces Central , 1 nc. Sout hf i el d M 0 f i ce 3000 Town Cent er Sui t e 3000 Sout hf i el d M 48075 USA CONTACT NAME` aC No. Ext): (866) 283 - 7122 I (�G. No.): (847) 853- 5390 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Bel f or USA G. oup, Inc. dba Bel f or Property Rest oration 1520 S. Power I 1 ne Road, Sui t e A Deer f i el d Beach FL 33442 USA "AVCItt At-SC ••••-•-•-•••••••- - -- - ..._ -___ ___ _ - -- _ _ -- INSURER A: Char t i s Speci alt y I nsur ance Conpany 26883 INSURER B: 1 nsur ance Conpany of t he St at e of PA 19429 INSURER G: Nat i onal Lhi on Fi r e I ns Co of Pi t t sbur gh 19445 INSURER D: $1, 000, 000 INSURER E: $1, 000, 000 INSURER F: $100,000 S • Iwm.. Ian. 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 I- TYPE OF INSURANCE ADD SUER D POLICY NUMBER i M/D • j It, DD LIMITS GENERAL X ■ ■ LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR e SI R appl i es per policy t er & condi _CAI 0 1 ons . EACH OCCURRENCE $1, 000, 000 Em • - F $1, 000, 000 MED EXP (Any one person) $100,000 PERSONAL &ADVINJURY $1, 000, 000 GENERAL AGGREGATE $2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n JEC'r n LOC PRODUCTS - COMP/OP AGG $2, 000, 000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ■ ■ ■ ANY AUTO ALL OWNED — SCHEDULED BODILY INJURY ( Per person) AUTOS HIRED AUTOS — NON -OWNED AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident X UMBRELLAUAB EXCESSUAB X II ( OCCUR II CLAIMS -MADE 23102164 07/ 01/ 2012 07/ 01/ 2013 EACH OCCURRENCE 5, 000, 000 AGGREGATE $5, 000, 000 DED RETENTION B C WORKERS COMPENSAT ON AND EMPLOYERS•LIABILITY Y/N ANY PROPRIETOR 1 N / A "SI35896312 ACS M35896310 FL 07 01 20 2 07/ 01/ 2012 07 0 20 3 07/ 01/ 2013 WC STATU- OTH- X TORY LIMITS ER OFFICER/MEMBER EXCWDED ?ExECUrIVE N E.L. EACH ACCIDENT $1, 000, 000 (Mandatory In NH) Byes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -EA EMPLOYEE $1, 000, 000 E.L. DISEASE- POLICY LIMIT $1, 000, 000 • DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) FE: Dalton Ita.l I . E f`CDTICIg, ATC LIAI nrn CANCELLATION M arri Shores Vi I I age Attn: Vi vian 10050 N. E. 2nd Ave. M anti Shores FL 33138 LISA ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Holder Identifier : Certificate No : 570047285416 e II AUTHORIZED REPRESENTATIVE Jgg'..I ` 496- 0Lmemo ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1-1E,CEIVtD JUL 3 1 if0 Sitting Room 12121 Stairs Laundry Datapak cabling - 0.0..545" Yellow BIu Green Dalton - 2nd Floor al 4 To Lobbyj n. • • • • • Stairs Front Desk APPRO\tED _TONING DEPT i'L-nC3 DEPT n CCMPr ANCE WTrH ALL FEDERAL { 141_,LE—IS AND REGULATIONS Stairs. Laundry Dalton - 1st Floor Revision 6/16/98 Terry Kushi -Pt144ACa Ir/.00g-fre4“-S (IJA-IF-423 (II g6x-ace u oot45 - la - too o - vi,a/pi;og. r;to P90145 ( Pookf5- MANUEL SYNALOVSKI ASSOCIATES, LLC 1800 Eller Drive, Suite 500 • Fort Lauderdale, FL 33316 • Telephone 954.961.6806 • Facsimile 954.96 NMCM5T7M AUG 2012 J August 8, 2012 Norman Bruhn Building Official /Director Miami Shores Village 10050 NE Second Avenue iami Shores, FL 33138 -2382 arty University Iton Hall Water Remediation and Repairs ruhn: GGI21440 bffer the following as definition of the scope of the unforeseen repair work required at the terior and exterior walls due to water leak remediation work at the North end of the First and Second Floors of Dalton Hall. Work is required to be accomplished this week as the students retum on August 12, 2012. The following rooms in Dalton Hall were impacted by the water damage: First Floor: 100, 101, 102, 103, 104, 105, 106, 107,1' Floor Lounge, Linen Closet, Stairs, Laundry Room and Hallway. Second Floor: 200, 201, 202, 203, 204, 205, 206, 207, 208, 2rIci Floor Lounge, Linen Closet, Stairs, Laundry Room and Hallway. The following typical wall types are to be utilized for the repair work to the interior and exterior walls of the affected areas: Interior Walls Remove damaged skim coat on the interior CMU walls, as required, and patch with new skim coat and paint. Exterior Walls Remove damaged sections on the exterior walls and provide with new wood furring strips, as required, at 24" o.c minimum and fastened at 6" o.c. minimum with T -nails to existing CMU walls. Provide and install new Thermafoil insulation (R -5 minimum) and install (2) layers of 1/2" Durock interior side fastened at 8" o.c. minimum and skim coat finish to match existing wall finish and paint. New floor finishes are to be installed in the affected areas as follows: First Floor: VCT (Vinyl Composition Tile) and Vinyl Base: 100 ,101,102,103,104,105,106,107, Linen Closet and Stairs MANUEL SYNALQV KJ A iA S; G oreh tectnre • interior MANUEL SYNALOVSKI ASSOCIATES, LLC 1800 Eller Drive, Suite 500 • Fort Lauderdale, FL 33316 • Telephone 954.961.6806 • Facsimile 954.961.6807 Carpet Tile and Vinyl Base: 1st Floor Lounge and Hallway Porcelain Tile and Porcelain Tile Base Laundry Room Second Floor. VCT (Vinyl Composition Tile) and Vinyl Base: 200, 201, 202, 203, 204, 205, 206, 207, 208, Linen Closet and Stairs Carpet Tile and Vinyl Base: 2`d Floor Lounge and Hallway. Porcelain Tile and Porcelain Tile Base Laundry Room Please f el,free to contact us should you have any questions or concems with the above. re u spectfl ly,_' Manuel Synal pyski, -AIA, LEED AP Manaiing Porter, h,628 MANUEL SYtsIALOVSKIASS RI , LLC. sechilecture rimming Datapak cabling - OD. .545* Yellow DaI • - 2nd I-loor Scope of Work for Water Damage Remediation Stairs To Lobby "" Stairs Laundry Front Desk SUBJECT TO COMPLIANCE WITH ALL STATE AND COUNTY RULES AND REGULATIONS oor evasion rry us I 1111111111111111111111111111111111111111111111111111111111111111111111111111111111 111 Derm Number: 2012-0810-0952-1672 Contact Name: MS SUNDAY CHAMBERLAIN Contact Phone: (520)235-7728 Folio: 11-2136-000-0050 Project Name: BARRY UNIVERSITY Date Received: 08/10/2012