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RC-13-1057Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 191687 Permit Number: RC -5 -13 -1057 Scheduled Inspection Date: June 04, 2013 Inspector: Bruhn, Norman Owner: UNIVERSITY, BARRY Job Address: 190 NW 111 Street Miami Shores, FL 33168- Project: <NONE> Contractor: PP3 CONSTRUCTION CORP Permit Type: Residential Construction Inspection Type: Final Work Classification: Repair Phone Number Parcel Number 1121360030480 Phone: (305)389 -0065 Building Department Comments REMOVE 5 AC WALL UNITS, PATCH OPENING & TILE FRONT STEPS Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed YrJ Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. June 04, 2013 For Inspections please call: (305)762 -4949 Page 12 of 24 Miami Shores Village Department p artment 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Buildin Y Tel: (305) 795.2204 Fax: (305) 756.8972 � 1� INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: BUILDING JOB ADDRESS: 190 NW 111th Street MAY I 5 2013 FBC 20 1� Permit No. Master Permit No. I � d 0S ROOFING City: Miami Shores County: Miami Dade Zip: 33161 Fo l i o/P arcel #: 11- 2136-003-0480 Is the Building Historically Designated: Yes NO X Flood Zone: OWNER: Name (Fee Simple Titleholder): Barry University, Inc. Address: 11300 NE 2nd Avenue Phone #: 305 - 899 -4050 City: Miami Shores State: Florida Tenant/Lessee Name: Phone #: Email: Zip: 33138 CONTRACTOR: Company Name: PP3 Construction, Corp. Phone #: 305 - 389 -0065 Address: 750 NE 96th Street City: Miami Shores State: Florida Zip: 33138 Qualifier Name: Gabriel Rodriguez Phone #: 305 - 389 -0065 State Certification or Registration #: CGC1516509 Certificate of Competency #: Contact Phone #: 305 - 389 -0065 Email Address: gabe@pp3construction.com DESIGNER: Architect/Engineer: NA Phone #: Value of Work for this Permit: $ 1,000.00 Square/Linear Footage of Work: 30 SF Type of Work: Addition ❑Alteration New URepair/Replace Description of Work: Remove 5 AC Wall Units , Patch Opening & Tile Front Steps ODemolition Color thru tile: ********* * * * * * *** **** * ** ****** ***** * * ** Fees******* ***: x****m: ua: ***m*** *****m***m:x*+x **** ** Submittal Fee $ Permit Fee $ /0 0 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ (.0 1. l 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 app o d and a reinspection fee will be charged. Signature Owner or Agent L The foregoing instrument was acknowledged before me this day of ANL, , 20 , by ENOS Ciblair who is personally known to me 2. who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: 4 Signature The fore mg instrument w day of G ,' , 20 who is personall own to me or who has produced NOTARY PUBLIC: tra acknowledged before me this/', by ii_?®0-1.- dee . identification and who did take an oath. Sign: Print: My Commission Expi . MARIE ELAINE RODGERS MY COMMISSION # EE136638 a EXPIRES January 25, 2016 ************************************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ,(fi9AMitlt+Mok* * *,F,19@ &g 9m APPROVED BY Plans Examiner Structural Review (Revised 3 /1 212 0 1 2)(Revised 07110 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk ACORb® CERTIFICATE OF LIABILITY INSURANCE � DATE(MMIDOlYYYY) 03/18/2013 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((es) 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 Merchant Insurance - Miami PO Box 173306 Miami FL 33017 *INNTEACT Stad Merchant �H ; (305) 804 2989 i; (866) 406 4983 nu MAIL smerchant@merchantinsurancesolutions.com INSURERS) AFFORDING COVERAGE NAIC 0 INSURERA: FUBA LIABILITY COMMERCIAL GENERAL LIABILITY INSURED PP3 CONSTRUCTION, CORP 750 NE 96TH STREET MIAMI FL 33138 INSURER B : INSURER C: INSURER D: $ INSURER E : $ INSURER F • COVERAGES CERTIFICATE NUMBER: 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 =BR IN1/p POLICY NUMBER POLICY EFF (MMIDD/YYYY1 POLICY EXP (MMIDDIYYYYI UNITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGERENTED PREMISES S (�a oawrrence)._ $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENI- AGGREGATE POLICY UMIT APPUESPER: PF r LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE — — _ LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS SCHEDULED AUTOS AUTOS �CEOMBBIINEEDSINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA UM EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER ELDE? PROPRIETOR/PARTNER/EXECUTIVE (Mandatory In NH) If yes describe wider DESCRIPTION OF OPERATIONS below Y/ N N / A 106 -49201 3/14/2013 3/14/2014 x WC STATU- TORY LIMITS OTH- FR E L EACH ACCIDENT $ 000 E.L DISEASE - EA EMPLOYEE $ 1,000,000 EL DISEASE - POLICY UMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AdditIonal Remark* Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLAT I The Village of Miami Shores 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 ACORD 25 (2010/05) © 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD