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ELC-10-861Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 150395 Permit Number: ELC -5 -10 -861 Scheduled Inspection Date: August 25, 2010 Inspector: Devaney, Michael Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Benincasa Hall Miami Shores, FL 33138 -0000 Project: <NONE> Contractor: MR1 CORP RATION Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360010160 -34 Phone: 305 -261 -6000 Building Department Comments August 24, 2010 For Inspections please call: (305)762 -4949 Page 24 of 26 Passed Inspector Comments CREATED AS REINSPECTION FOR INSP- 143436. approval of revisec plans & exhaust fan's installed. occupancy. ccvbn 1 /`' Partial final pending Building is safe for ) ;;,1 Failed _. 7----td 7� Correction Needed Re- Inspection Fee No Additional Inspections can be re- inspection fee is paid. scheduled until August 24, 2010 For Inspections please call: (305)762 -4949 Page 24 of 26 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 FBC 20 Permit Type: ELECTRICAL Owner's Name (Fee Simple Owner's Address INS A t City 1-14, A Sins Tenant/Lessee Name Email Permit No. IG 10-ko f Master Permit No. G 1 o -4540 Titleholder) .3AQ -tLy t j i v Si rti Phone # 3 c'S- 8°r 9- 1913" Nf, 2.017 state rrC, Zip 33t(er Phone # Job Address (where the wor is being done) 19.0 IJ6t t5414 41' City Miami Shorts Village County Miami -Dade Zip -53 i ` FOLIO / PARCEL # Is Building Historically De ignated YES NO )C Flood Zone Contractor's Company Na Contractor's Address City W e MRS 4,0c_Forz4.1r01J vsw Is* SU%rs Zot Phone # , .S" -Z6 - & o 0 tv, VAR.�Z. State (� zip 3314'4 Phone # ton No. caZfrg(ey chitect/Engineer's Name E -mail Certificate of Competency No. if applicable) Phone # A. Value of Work For this Permit $ 5, 0 0 0 Square / Linear Footage Of Work: Nl/4 Type of Work: R.ilidditi on ❑Alteration :New ❑ Repair/Replace ❑ Demolition Describe Work: X44n1t 01 Qvo/ tC 4-0,44-4v eklik vto fawl5 Submittal Fee $ Notary $ Scanning $ -� Double Fee $ Structural Review. $ Permit Fee $ 07756 3 e/L CCF $ CO /CC $ Training/Education Fee $ Technology Fee $ Radon $ DPBR $ Bond $ Violation date: Total Fee Now Due $ Ci O See Reverse side -� Bonding Company's Name (if applicable) Bonding Company's Address v 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,. QQLS, EJ. WACES, BOILERS, HEATERS, TANKS3ai�d AIR CQQ11 I:IONERS, ETC b a OWNER'S AFFIDAVIT: I certify that all the foregoing information fsraddMVatelandirant all vbrk will be'done in compliance with all applicable laws regulating construction. 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 bitildirig` permit Ps issued Ir! the absence of such posted notice, the inspection will not be a ov d and a re- inspection fee will be,chgrgedt; !°' Signature Owner or Agent The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this Ica, day of , 20 1_0_, by VA46 fjoktrI1' , day of y`1� -` , 20 k ®, by who is personally known to me or who has produced As identification and who did take an oath. NOTARY ' UBLIC: Signature :' -., )' 4 Contractor Sign: Print: My Commission Expires: 11 / P Notary Public State of Florida Jeffry J Yao My Commission DD613542 2/to ID who is personally known to me or who has produced as identification and who did take an oath. NOTARY 'PUBLIC: APPROVED BY -� .> z )2ee,y /e Plans Examiner Engineer (Revised 07 /10 /07)(Revised 06/10/2009) •''''i a RICARDO LUIS TROITINO Sign: � �� IV/ MY COMMISSION # DD 583047 � :, :� /ice ,u<an �� E,y Print: NT �� = � My Commission Expires: Zoning Clerk checked BUILDING PERMIT APP FBC 20 Permit Type: ELEC Miami Shores Village Building rEEVIElh u ding Department 0 0) 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305).762.4949 ` t: ••••••••••• >•'•• Permit No. E1L 10 Master Permit No. 4c- ' -'-Vg( ICATION RICAL Owner's Name (Fee Simple itleholder) 4y2-R O'&'4 Phone # $at9 - 304-2 Owner's Address 11300 N 2' Av¢vtvt, City KAM S ore. State Zip 3316 Tenant/Lessee Name Email Job Address (where the work City Miami Shores FOLIO / PARCEL # 11 Phone # is being done) i40 Nub 114-' STS - 3fiuog f -age iTe014 2. tsgi maisq. Village County Miami -Dade 2136- poo - oo°lo Is Building Historically Designated YES NOx Contractor's Company Name Contractor's Address S14, 2 Zip 331•1 11',- Phone # gig2S iSr City NA, P-t—t Qualifier Name t F f State Certificate or Registratio Contact Phone L State F L'y AL EZ Zip Flood Zone 3b5 ZG1 G000 Phone # 5 o j Z% 4 n No. Ee 4 o 2G Si Architect/Engineer's Name (if applicable) Value of Work For this Per Type of Work: ❑Additio Describe Work: 4400.1 l' E -mail CQ ooO Certificate of Competency No. Phone # it$ &,9e° ['Alteration Square / Linear Footage Of Work: 1 CVO :New gj Repair/Replace ['Demolition tK Ti-AT /w.fy y+ W -$1144 1'iXTU 4z. RFa M iGA Waly4. i1R.ti trosrAu.xb C.a�o�E�cLY ft.4%. ., Go'DE Wect. DityvAtt. Zs4 t -ovrep , wopt, *f4 DpaE LirllTT,p Toe Nita K P�a'R1 eo�Ms ************* Submittal Fee $.0-C AD Notary $ Scanning $ Double Fee $ Structural Review. $ * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * ** * * * * * * * ** Permit Fee $ 4-KO" CCF $ °I'00 CO /CC $ Training/Education Fee $ Technology Fee $ ).R.00 Radon $ SS' 00 Violation date: Total Fee Now Due $ ✓ ��jj 31.00 See Reverse side -> DPBR $ Bond $ 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 appro /411-11.7%," : nd a re- inspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this f 1 day of l P y , 20 i, by '1 'k\) (j/ 1),Rg-. who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Public Stiittiii7firlit e' J Yao -M I ion ON13 42 �xIres 11/12/201 v Contractor The foregoing instrument was acknowledged before me this ' 4— day of !A 0'1/4'1 , 20 _, by Ri' FAt ` vkt�14 24'Z , who is•personalIY knoiy to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: APPROVED BY 2— /9,'6,V/7 Plans Examiner Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Zoning Clerk checked ACORD CERTIFICATE OF LIABILITY INSURANCE 1 8/2288/200099 PRODUCER (305) 714 -4400 FAN: (305) 714 -4401 BROWN &BROWN INSURANCE -IBA DIVISION 2500 NW 79th Avenue Suite# 101 Miami FL 33122 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 NAJC S INSURED MR1 Corporation 5742 Sw. 7th Street Suite 201 Miami FL 33144 INSURER A.. FCCI Insurance Company INSURER B: INSURER C: INSURER D: INSURER E: COVERAGES THE POUCtES OF INSURANCE USTED BELOW REQUIREMENT, TERM OR CONDITION OF ANY THE INSURANCE AFFORDED BY THE POL AGGREGATE LIMITS SHOWN MAY HAVE BEEN HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING Al CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAI CIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICE REDUCED BY PAID CLAIMS. INSR 4712 ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTPIE DATE (MM100IYY) POUCY EXPIRATION DATE ($ MIDDJYY) LIMITS A GENERAL �X LIABILITY COMMERCIAL GENERAL LIABILITY CPP0005309 9/1/2009 9/1/2010 EACH OCCURRENCE $ 1,000,01 PREMISES GE TO occurrence) $ 100,0( M,EO XP1A,ly ) $ 5,0( I CLAMS MADE ) i 1 occuR PERSONAL BADVINJURY $ 1,000,0( GENERAL AGGREGATE $ 2,000,0( PRODUCTS - COMP /OP AGG $ 2,000,0( GEN'L AGGREGATE j&C GAAT�E LIMIT APPLIES PER POLICY 1 1 I PL I LOC A AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS = CA0006320 , 9/1/2009 9/1/2010 COMBINED SINGLE LIMIT (Ea accident) $ 300, 0( BODILYINJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGEIJABIUTY 1 ANY AUTO AUTO ONLY - EAACCIDENT S OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA —1 LIABILITY OCCUR 1 1 CLAIMS MADE DEDUCTIBLE RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ $ $ WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS be WC STATU- Off{ 1 TORY LIMITS 1 I ER E.L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES !EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPARTME T 10050 NE 2ND AVE MIAMI, FL 33138 SHOULD ANY OF THE ABOVE DESOMBED POLICIES BE CANCELLED BEFORE THI EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MA$ 10 DAYS WRITPEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BU' FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON TH INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE -ac H INSURANCE GROUP /JG1 '-- ACORD 25 (2001108) INS025 (o1OB)A8a Page 1 ACORD,, CERTIFICATE OF LIABILITY INSURANCE DATE {DD1YY1 02/12/2010 PRODUCER USI INSURANCE SERVICES, LLC 555 PLEASANTVILLE RD. 3RD FL, NORTH BLDG BRIARCUFF MANOR, NY 10510 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMAT(OI ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW INSURERS AFFORDING COVERAGE ! MAIM INSURED 3348 STRATEGIC OUTSOURCING, INC. PO BOX 241448 CHARLOTTE, NC 28224 INSURER A: TWIN CITY FIRE INSURANCE COMPANY INSURER B 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 POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. tfAl TYPE OF INSURANCE GENERAL UABILITY 1 COMMERCIAL GENERAL L : ILIiY JCLAIIMSMADE GENI. AGGREGATE U IY S PER 1 POLICY n JPRELCTI. LAC POLICY NUMBER Sr" PRIM EACH OCCURRENCE $ WA !Ea $ ADIDIAP Mier te r&on) $ PERSONAL & ADV INJURY 1$ GENERAL AGGREGATE I $ PRODUCTS - COMPIOP AGO 1$ AUTOMOBILE LIABILITY ANY AUTO ALL OV #ED AUTOS SCHEDULED AUTOS �. HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ee Ac dent) $ BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG EXCESSIUMBRELLA LAB OCCUR ®CLAD DEDUCTIBLE t 'RETENTION S A WORKERS COMPENSATION AI EMPLOYERS' LABILITY ANY PROPRIETORIPARTNERIE)IEC IOFFeFIICERIMEMBER EXCLUDED? SPEUtIAI PROVISIONS below 16WBRJ79226 03/01/2010 EACH OCCURRENCE AGGREGATE X 03/01/2011 F R a H s I I EL EACH ACCIDENT 1,000,00 EL DISEASE -EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIT $ 1,000,00 OTHER ( I DESCRIPTION OF OPERATIONSILOC T(ONSNEH1CLESSEXCLUSIONS ADDED BY ENDORSEMENTISPEC(AL PROVISIONS LIMITED TO EMPLOYEES LEASED TO MR1 CORPORATION BY STRATEGIC OUTSOURCING, INC. JOB: BARRY UNIVERSITY FAX: 305- 261 -6674 FAX: 305- 756 -8972 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VI`LAGE BUILDING DEPT. 10050 NE 2ND AVENUE MIAMI, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIUI DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAB. 30 DAYS WRIT NOTICE TO THE CERTIFICATE HOLDER NAMED TO 7115 LEFT, NUT FAILURE TO CIO SO Mb IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OS REPRESENTATRIVES. ACORD 25 (200110 ACORD CORPORATION 1 T SEE OTHER SIDE DO NOT FORWARD MR1 CORP RAMON MESA PRES 5742 SW 7 STREET #201A MIAMI FL 33144 I „11, „11,,,,11,1,.1,1 „1„ 11,1,1,.1,,,1 „1, 1,I,1 „.,,O ,i :SEQ #f;Q8, 9.130.0. 631:.! • • T'2e �'ECR IGl�r��;i 1�rider ' t ' OV f�r, Expiration ;date `� .��, . � Fes.- ;__�f;.'ii :3:•..:•.jy ��, • .) #_) 574 V!SW' (i7T sST . S MIAMI .. rvi