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CC-12-2432Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 184219 Permit Number: CC -12 -12 -2432 Scheduled Inspection Date: January 15, 2013 Inspector: Bruhn, Norman Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Renne M. Hall Miami Shores, FL 33138 -0000 Project BARRY UNIVERSITY Contractor: NEW LIVING CONSTRUCTION INC Permit Type: Commercial Construction Inspection Type: Final Building Work Classification: Alteration Phone Number Parcel Number 1121360010160 -18 Phone: (954)237 -4731 Building Department Comments REPAIR WATER DAMAGED DRYWALL Infractlo Passed Comments INSPECTOR COMMENTS False Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments Itr1Y 3cT•"lfol• �' � �i4 January 14, 2013 For Inspections please call: (305)762 -4949 Page 19 of 19 i UII� G PERMIT APPLICATION 1V11Q1111 t3i1U1 f:.b 111agG 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 C DE F 2 6 2912 s Permit No. X �/+C a N- Master Permit No. Permit Type: BUILDING ROOFING JOB ADDRESS: EAt'/� ,(,�t1r/e'Sl (100 GfilP'm(6- 1AfI /68) 1.3a9 A76 rvdAle City: Miami Shores County: Miami Dade Zip: 33/6 / Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): 4/W f �/r//'�rs/ Phone#: 305-'8'7 g' 37e.T Address: / / 30a / i f 2 fi✓d ( f City: MAN S'd O(C sue: Zip: 33167 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: ,4/ t a9-7 oelf: ,1r Phone#: 3057-7‘/ WVc" Address: /35 e g // 4/ 6,40/Ai Nye/ VZ.‘ City: A/ /A,vc 1(€ bead .state: Zip: 3300? � Qualifier Name: Ai t <r j2 - N / Phone#: 3 ©r -76r'tiy'%/f State Certification or Registration # ::tedc WHO 98 y8 Certificate of Competency #: Contact Phone#: 30 I ,X /- 7 �/ ' Yi Email Address: 4/47/' 617/1/2‘ ear/ DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ /® 300 • 00 Square/Linear Footage of Work: 6® gB P Type of Work: OAddition ©Alteration UNew , Repair/Replace t lt)emolition Description of Work: e ' ,4i WAWA l eeC( dereAl Color guru tile; ,Dec Subnuttal Fee $ Permft Fee $ //5V CCF $, CO /CC $ Sunning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ 1 1 0 1 TWAT. FT.F. NOW MIR t Bending 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 wilt not be approved;,, a reinspection fee will be charged Signature Signature Owner or Agent Contractor pp The foregoing instrument was acknowledged before me this t The foregoing instrument was acknowledged before me this t to day of DET:aa, 20 .1.7L by 'muck 8W u►A2uY , day of a CAPA4,01,9-4- , 20 by 'AIL q _ '0‘1 who is personally known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: 10.29...A-Q. lam( c�,o - Print:i PM Pr RA a_ uotAgc, L I v My Commissio Expires: e e • TAMARA GLOWACKA -LEIVA „.01T44,„ Notary Public - State of Florida �• �? AD 8 4 ********************************* .• a: Commission # DD 893378 Structural Review (Revised 3 /12t2012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) mna +• Bonded Through National No Assn. 0 Clerk aefalar==."12.7411 ligatira," 4%=.jig=====ffi== teraneSMEMEME12.= 777511611 PINE ALMA( PLAN (SE0ND WOR) APPROVED BY DAII ZONING DEPT BLDG DEPT SUBJECT-10 CCMPLIANCE NTH ALL FEDERAL STATE ANO CCUNTY fRULES AND REGULATIONS DEC 2 6 Z012 _ 50'\\ STATE V141V ,Lcufwv SO STATE SECURITY MINCE. 24 1 23 NZ 125th STREET North Wornl. Fl. 33181 (2319891..7000 'f70008111 REVISIONS DOM MOM PJL rocat soimmss.104.4.. MOW NM NOM Ms WM 11,40,9 03311114 SHEET KU FA-02 02 OE 03 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 DAIN, DMITRIY P NEW LIVING CONSTRUCTION INC 1835 E WALLANDALE BEACH BLVD #426 HALLANDALE FL 33009 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.myfforldalleense.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 THIS DOCUMENT HAS 'A COLORED BACKGROUND • C #6202449 STATE OF FLORIDA, DEPARTMENT OF PROFESSIONAL CGC1509848 07 CERTIFIED DAIN, DMIT Y P NEW LIVING ' COAST AC##I, 20 244.9 BUSINESS AND ,REGULATION IS CF TIFIED under the provisions of ch.489 Ba. r 3*^a +4an date.. AUG . 31, ' 20.14 :L12071400328 IICROPRINTING'• LINEMARK "` PATENTED 'PAPEER. STATE OF FLORIDA DEPARTMENT OF BU NESS AND PROFESSIONAL R$ LATION CONSTRUCT ON INDUSTRY LICENSING BOARD acute L12071400328 NUMBER LICENSE NBR 015470. CGC1509848�� BATCH 120 ;The GENERAL CONTRACTOR .Named below IS CERTIFIED 'tinder the provisions of Chapter-.: Expiration dates AUG 31, 2014 DAIN, DMITRIY P NEW LIVING .:CONSTRUCTION INC 1835 L WALLANDALE BEACH BLVD 4 HALLANDALE FL 33009 RICK VERR OR DISPLAY AS REQUIRED BY LAW KEN LAWSON SECRETARY BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954- 831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30,2013 DBA: Business Name: NEw LIVING CONSTRUCTION INC Receipt #:18G 0- 687 CONTRACPOR Business Type:CONTxACxoR) Owner Name: DMITRIY P DAIN Business Opened:05 /18/2006 Business Location: 1835 E HALLANDALE BCH BLVD 42 (State JCounty /CertlReg:CGC1509848 HALLANDALE Exemption Code: Business Phone: 305-761-4444 Rooms Seale Employees Professionals For Vending Business only Number of Machines: Vending Type: l 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 andlor Municipality planning WHEN VAUDATED 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 laws and regulations. Mailing Address: DMITRIY P DAIN 1835 E HALLANDALE BCH BLVD 426 HALLANDALE, FL 33009 2012 - 2013 Receipt #30A -11- 00003583 Paid 07/27/2012 27.00 .waM.a aLa l.►w_.. a �_. _.e... Al. _._ '., "•.....,01M ••• ..Ia _OIL Vo .•..OW ■ ACCORD CERTIFICATE OF LIABILITY INSURANCE D;27`; ar' 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 poitcy(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 Frank E. Furman, Inc. 1314 East Atlantic Blvd. P. O. Box 1927 Pompano Beach FL 33061 xAACT Lisa O' Brien . (954)943 -5050 ti, ,sa:(954)942.6310 LI A :lisat!furmaninsurance.com ) AFFO COVERAGE HNC # Im omA,$cottsdale Insurance Co 41297 INSURED New Living Construction Inc 1835 East Hallandale Beach Blvd Suite 426 nallandale Beach FL 33009 INSURER B : _ _I, 0001506547 INSURER C F 1/22/2013 mono D: $ 1,0001000 INSURER E: $ 100,000 INSURIRF: __ L,..2. �.'rllsi •,�,-_ f:?d PERSONAL &ADVINJURY CLsRitEICprn M1{MBER. L 2012 -2013 Master UMBER: Wirtilmurp THIS IS TO CERTIFY THAT THE POLICIES INDICATED. NOTWITHSTANDING ANY REQUIREMENT, CERTIFICATE MAY BE ISSUED OR MAY EXCLUSIONS AND CONDITIONS OF SUCH OF INSURANCE IJSTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VI&IICH THIS PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU. THE TERMS, POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Fl I' A TYPE Of INSURANCE 11'011L-11 i 1, ' • L.� ,i o nL. eS '.,ll[il EtP 1 :1l .111 / GENERALLY x .■ ■ ■ COMMERCW. GENERAL. unarm CLAIMS -MADE n OCCUR i _ _I, 0001506547 1/22/2012 1/22/2013 EACH OCCURRENCE $ 1,0001000 '- $ 100,000 r , �!1�:� 1<<;�� =, __ L,..2. �.'rllsi •,�,-_ f:?d PERSONAL &ADVINJURY $ 5,00'° $ 1,000,00+: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000, 00' �GEEN'L AGGREGATE LIMIT APPLIES PER: ■.1 POLICY . P ■ OC 'q xe $ AUTOMOBILE ■ ■ALL ■ LIABILITY ANY AUTO OWNED Autos HIRE) AUTOS SCHEDULED NONOWNED Amos •Ti X137 = -� :3L BODILY INJURY (Pnr perm} $ BODILY INJURY (Per accident) •������•�,__. s � °i1 $ $ $ rUMBRELLA LAB EXCESS LAB f ____ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ WORKERS AND ANY (Ms/Watery ff DESCRIPTION COMPENSATION EMPLOYERS'UABILUY Y/N PROPRIETORIPARTNERIEI(ECUTIVE ❑ In EXCWDED? under OPERATIONS N rA Tf}RY LIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EIIL • �: $ E.L. DISEASE - POLICY LIAlAT $ DESCRII N OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101. Additional Remml%Sehedale if more space is required) CERTIFICATE HOLDER Miami Shares Village Building Department 10050 ME 2nd Avenue Miami Shores, FL 33138 ACORD 25 (2010/05) INR075 onannsl ni 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 Frank Furman, Jr /LT 01988-2010 ACORD CORPORATION. All rights reserved. Th.,. *moan mama anti Is.nn arc , , Ictmromf market oh Annan 07 -18 -2012 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: PERSON: FEIN: 09/12/2012 EXPIRATION DATE: 0911212014 DAIN DMITRIY P 203075304 BUSINESS NAME AND ADDRESS: NEW LIVING CONSTRUCTION INC 1835 E. HALLANDALE BEACH 0428 HALLANDALE BEACH FL 33009 SCOPES OF BUSINESS OR TRADE: 1- LICENSED GENERAL CONTRACTOR IMPORTANT: Pursuant to Chapter 440 . 05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election ender this section may net recover benefits or compensation coder this chapter. Pursuant to Chapter 440.05{12€, F.S.. Certificates of election to be exempt.. apply only within the scope of the business or trade listed no the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shell revoke e certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? 18501 413-1609 OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS COMPENSATION CONSTRUCTION INDUSTRY CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW EFFECTIVE 09/12/2012 EXPIRATION DATE: 09/12/2014 PERSON: DMITRIY P DAIN FEIN 203075304 BUSINESS NAME AND ADDRESS: NEW LIVING CONSTRUCTION INC 1835 E. HALLANDALE BEACH 0426 HALLANDALE BEACH, FL 33009 SCOPE OF BUSINESS OR TRADE 1- LICENSED GENERAL CONTRACTOR IMPORTANT et F Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election �- under this section may not recover benefits or compensation under this D chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be H exempt.. apply only within the scope of the business or trade listed on E the notice of election to be exempt E Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. QUESTIONS? (850) 413 -1609 CUT HERE * Carry bottom portion on the job, keep upper portion for your records. OWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01 -11