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CC-13-572Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 192325 Permit Number: CC- 3- 13-572 Scheduled Inspection Date: May 30, 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: BELFOR USA GROUP INC Permit Type: Commercial Construction Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1121360010160 -18 Phone: (954)275 -1977 Building Department Comments REMOVING 24" DRYWALL FROM BOTTOM TO TOP AND REPLACE IT WITH NEW DUE TO A WASTE WATER FLOOD Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. May 29, 2013 For Inspections please call: (305)762 -4949 Page 13 of 18 5" 0113 BUILDING ' Miami Shores Village Building Department 13 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 2010 Permit No. eC / 13-n12 PERMIT APPLICATION Master Permit No. Permit Type: BUILDING JOB ADDRESS: 1 1 3( j 2 ROOFING -1 ✓e Ir-trn i C'Yrve s -► City: Miami Shores County: Miami Dade Zip: 3.31 Lo 1 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder):1761fri 1 11 i verg I -1 Phone #: Address: 11 ?)00 2'4 ()v City: f 1►cim i K" j State: (41(ri°j Zip: 531 t. 1 Tenant/Lessee Name: ►.1/ 14=i Phone #: Email: CONTRACTOR: Company Name: 1W 1 r LM Phone #: 1-1- --, )f e I `.-i f! Address: 10-2_0 r) upPir I rr Pd City: F'trgIP State: (4l Zip: &51Lo I Qualifier Name: arm CCt 71 le S Phone #: q�-i- - 1 °eqtr. State Certification or Registration #: C1°-sC 15 11c145 Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ ,;r 00 . C,® Square/Linear Footage of Work: EO0 Type of Work: ❑Addition DAlteration ONew l tepair/Replace ODemolition Description of Work: trrver'0 dto ICy <"tu f c, rJ rr'pf' n' I.i//j 1 r u1 Aftl it Color thru tile: De. ******** *** * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees**,********** * * * * * * * * * * * * * * * * * * * * ** * * * * * * * ** Submittal Fee $ Permit Fee $ /j2 es" 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 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 afier the building permit is issued. In the absence of such posted notice, the inspection will not be app,, ed and a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of M Aa-CA , 2013 , by KiLtl06 6J INNYS who is personally known me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign. Print: My Commission Exp * * * * * * * * * * * * * * * ** APPROVED BY Signature Contractor The foregoing instrument was acknowledged before me this Dell day of (rrircb , 20 e P.), by Vtrnteliki °'firth 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: etq KP Kimberly tahm S COMMISSION 1 EEI69 `rg EXPIRES: Fea,16, 2 Meow Plans Examiner Zoning Structural Review Clerk (Revised 5 /2 /2012)(Revised 3/12/2012) )(Revised 06 /10 /2009XRevised 3 /15 /09XRevised 7/10/2007) °It .41. CERTIFICATE OF LIABILITY INSURANCE 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). I DATE(MMIDDNYYY) 1110612012 PRODUCER Aon Risk services Central, Inc. Southfield MI Office 3000 Town center Suite 3000 Southfield MI 48075 USA (AiC. Na (866) 283 -7122 INSURED Belfor UsA Group, Inc. dba Belfor Property Restoration Deerfield BeachnFLR33442sUSAe A E -MAIL ADDRESS: 1 INC. N0.) (M7) 953 -5390 INSURERS) AFFORDING! COVERAGE 01guRERA: Chartis Specialty insurance Company National union Fire ins Co of Pittsburgh INSURER B: INSURER C: Insurance Company of the state of PA NAIL 9 26883 19445 19429 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570048155356 REVISION NUMBER: 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSR �� SUBR POLICY EFF O.r exP LT R TYPE OF INSURANCE WSR WVD POLICY NUMBER / 01/0 L 0 B GENERALUABd11Y SIR GL9612839 _ SIR applies per policy ter & conditions X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE © OCCUR GEN'L AGGREGATE LIMIT APPLES PER: 7 POUGY n JECT I ^ I LOC AUTOMOBILE LIABILITY X X X B c ANY AUTO ALL OWNED AUTOS HIRED AUTOS — SCHEDULED AUTOS - NON -OWNED AUTOS X Comp Ded ,1.000 X Coltislnn Ded 57.000 x UMBRELLA LU1B EXCESS UAB LIMITS EACH OCCURRENCE $1,000,000 CA 1707562 107/01/2012 07/01/2013 X OCCUR CLAIMS -MADE OED I (RETENTION 7T\d,rZc • -7y PREMISES (Ea omunenoe) WED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMPIOP AGO $1,000,000 $100,000 $1,000,000 $2,000,000 $2,000,000 23102164 07/01/2012 07/01/2013 WORKERS COMPENSATION AND EMPLOYERS' UABILTY ANY PROPRIETOR /PARTNER /EXECUTIVE OFPICEWMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN NIA WC035896312 AOS wC035896310 FL 07/01/2012 07/01/2013 07/01/2012 07/01/2013 COMBINED SINGLE LIMIT a BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE 5 51,000,000 0 3 01 $5,000,000 v $5,000,000 XIroY$LTMUS 1 IER EL EACH ACCIDENT $1,000,000 EL DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE -POUCY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more spare is required) Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION Belfor USA Group, Inc. dba Belfor Property Restoration 1520 5. Powerline Road Suite A Deerfield FL 33442 USA SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE 114E EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD V THIS DOCUMENT HAS A COLORED BACKGROUND • MICROPRINTING • LINEMARK"' PATENTED PAPER T ?F FLO e AND Xk T ° • ' "S'EQ#LI;07�.],D15? 1. WER 4ING$AM • ' . • 3/21/2013 BELFOR 1520 S Power line Road Suite A Deerfield Beach, Florida 33442 954 -596 -8989 Norm; VA We had a water loss from an overflowing toilet at Mottram Doss Hall unit 4 & 2 on Saturday March 16th. It has contaminated two dorm rooms & a bathroom upstairs in unit 4 & two dorm rooms & a bathroom downstairs in unit 2. The permit application is in housing & we should have it signed & turned in tomorrow. The students have been relocated out of the dorm rooms. I would like to have permission to remove the drywall 2 feet up from the floor in the perimeter of the four rooms while the permit is being processed before we have any microbial growth. Timing is of the essence since housing would like this to be repaired over Spring Break. Thank you & regards Kirk Warrior�l�- ./ BELFOR NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF FIRST INSPECTION PERMIT NO. TAX FOLIO NO. STATE OF FLORIDA: COUNTY OF MIAMI-DADE: THE UNDERSIGNED hereby gives notice that Improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement 111111111111Mili CFN 21013R0223318 OR Bk 28544 Ps 2467; (lps) RECORDED 03/22/2013 14328:04 HARVEY RUVIN, CLERK OF COURT MIAMI7DADE COUNTY, FLORIDA LAST 'PAGE Space above reserved for use of recording office 1. Legal description of property and street/address: (nC)+Vrelfr) elT.)-sert5 —113C)C) CN.r. rue' ') CnicilrVA aT)IrP'S ) L .31to • 2. Description of improvement ilks• 1111 3. Owner(s) name and address: Interest in property: Otory-r Name and address of fee simple titleholder: 4 Contractor's name, address and phone number: e 141 cir-)4- .P.f;tfoR 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number: Amount of bond $ 6. Lender's name and address: t f 7. Persons within the State of Florida desgnated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number. rr kir .1 e r 1:=1 531(0 is- Co, 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Uenor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number: 9. Expiration date of this Notice of Commencement (the expiration date [al year front the date of recording unless a different date Is spechled) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION,. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTIC F COMMENCEMENT. Signature(s) of Owner(s Prepared By Print Name er(s)' Authorized Officer/Director/Partner/Manager Prepared By Print Name Title/Office Title/Office Viek V STATE OF FLORIDA COUNTY OF MIAMI-DADE The f�reaolna instrument was rowledged before me this BY 1.1 Clg -10U4 la Individually, or as V - r for OPersonally , or ta produced the following type of identMcat Signature of Notary Public: day of Migraii . 7.012 Under penalties of perjury, I declare that that the facts stated In it ar e, to the /Orr Signature(s) of Owns By 129.01-02 PAGE 3 8/10 er(s)'s AuthorizeaOfficer/DIrector/Partner/Manager who signed • By f o■vg. IBM AD IsiSed Us% 4 DTP %rrL) LinrsJ Thrcrni Ebss F1/ - - Uni{s 2 nrre ` or pkj -)P Rc c*T.5 A C in ecicH uni4 - 2 ,S ©n 4he l 'Fier - Fbor nob+ atowZ -Ficericut due -b uxrf!r dur n3e ‘,:i ami Shores ViilEge APPRO\; ED ZONING DEPT BLDG DEPT SUBJECT 10 CONIPLI?'NCE WI rH ALL FEDERAL STATE ANv C( UN i f H S ND REGULATIONS /9 _ Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 13, Inspection Number: INSP - 187924 Permit Number: PLC -3 -13 -574 Scheduled Inspection Date: May 16, 2013 Inspector: Hernandez, Rafael Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Renne M. Hall Miami Shores, FL 33138 -0000 Project: BARRY UNIVERSITY Contractor: A -1 QUALITY PLUMBING CORP Permit Type: Plumbing - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360010160 -18 Phone: (954)912 -4700 Building Department Comments DISCONNECT AND RE SET TWO VANITIES DUE TO OVERFLOWN Infractio 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 May 15, 2013 For Inspections please call: (305)762 -4949 Page 8 of 38 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 No. CA A- 51`x- PERMIT APPLICATION Master Permit No. W 13 — 51 e9— FBC20VZ::. Permit Type: PLUMBING Uri f/Phone# OWNER : Name (Fee Simple Titleholder): Pair (4 U� ii i I/ e(51 ' C t_ ©o N� a ^d A-0-e.. fl Address: � City: __11/4.0i FL Zip: , Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: 0on)EandA-Ve. City: Miami Shores / County: Miami Dade Folio/Parcel#: I" a 1 310 a 000 ` OD S Is the Building Historically Designated: Yes NO Flood Zone: Zip: n6!1 CONTRACTOR: Company Name: A-1 QLf QJI {y ') tomb i { 3 O{Jr� Phone#: 954-9 /�- 2O Addres • 1 ©5.5 N 3 I s-P ,M ---/// City: • (Yl 1 l ,„ r` y 1 State: F Lo F-lDA- Zip: 3 300 Qualifier Name: L LC __ U) D l G1�� n 66O`% Phone#: 9 ,5 '- ,3 Lf 6 500 State Certification or Registration #: C FC 0 g-75,94) Certificate of Competency #: Contact Phone#: Email Address: t .i gajt$J jlurnbi oL3#— y o cl DESIGNER: Architect/Engineer: / Phone# ✓: / Value of Work for this Permit: $ i 50 0 00 Square/Linear Foo o e of Work: Type of Work: DAddress DAlteration O B New epair/Replace Demolition Description of Work: bi Jr C On Ile Cf at" 41 'e 6 e -F Y u I T n (1 n '4 4 Off - �1 Va.nI4- '(/ U11I+4 4 Submittal Fee $ Permit Fee $ �d CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ t)) ) 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, BO)LERS, HEATERS, TANKS and AIR CONDmONERS, 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 WITII 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 a reinspection fee will be charged. Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before we tthiss 1 .„,„... �+1_ day of , 20 [3, by 4i app 2j , day of a' 20 . , by L ce r l l k 1 % ii 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 tare °math: NOTARY ' UBLIC: NOTARY PUBLIC: "` ` As identification and who did take an oath. Sign: Print earrim 1 My Commission Expire * * * * * * * * * * * * * * * * ** APPROVED BY Print: Li /) et b. a l e it r9 3+ 3# I ®e quo, �i My Commission Expires: 5 - f 1— c/ 3 ....ti o� , 'o 0 0 w to �� ***************** �x *x�x�a�****x�m�x�x****�x**** *� *** ***mix * * *** **** ** 4' '--1.3 Plans Examiner Zoning Structural Review (Revised 07110 /07)(Revised 06/10 /2009)(Revised 3/15/09) Clerk Rightfax C3 -2 3/19/2013 9:02:52 AM PAGE 2/002 Fax Server a`°R1 CERTIFICATE OF LIABILITY INSURANCE o9`" �° 3"'' 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 INSURERS). 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 Ileu of such endorsement(s). PRODUCER AUTOMATIC DATA PROC INS AGCY INC 1 ADP BLVD MS 325 ROSELAND, NJ 07068 (877) 677 -0428 XV770 70A ►t I • •f',. . Eat): (877) 677 -0428 r(q� �lvcr, No): (877) 677 -0430 ADDRESS: spcblcatip@trevalers.com PRODUCER C JSTCNERID#: 2908X4167 AFFORDING COVERAGE NAIL# INSURED A -1 QUALITY PLUMBING CORPORATION 1055 NW 31ST AVENUE POMPANO BEACH, FL 33069 INSURER AfT ETRAVELERS IM)EIVI 7YCONPANYOF ANERICi1 INSURER B: INSURER C: INSURER D: $ INSURER E: $ INSURER F: CIA] M3 -MADE COVERAGES CERTIFICATE NUMBER: 302368712001870 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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. L TYPE OF INSURANCE I L PQJCYNUMBER ( DDDryy�yYI POUCY UP UNITS GENERAL LIABIITY CCMVIERCIAL GENERAL LIABILITY D OCCUR EACH OCCURRENCE $ DAMAGE I O HEN I EU PRHNISES (Ea acamerne) $ CIA] M3 -MADE MED RP (Anv rue person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE UMIT APPLIES PER: 7 POLICY 1—I JECT 1—I LO PRODUCTS - CCMP /OP AGO $ $ AUTOMOBILE _ — IJABILJTY ANYAlJTO ALL CANNED AUTOS SCHEDULED AUTOS HIRED AUTOS AUTOS CCM3INEDSINGLE UNIT (Ea accident) $ BODILY INJURY (Per pawn) $ BODILY IIMJURY(Per acddent) $ pa aettUE $ $ $ UMBRELLA LIAR EXCESS LIAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ — DEDUCTIBLE RETENTION $ $ $ A � UO NAT Y/N ANY PROPRIETOR/PARTNEFVE ECUTNE ❑ EPINO EXCLUDED? under SECIALPSI below N/A UB- 3B274100 -13 03/16/2013 03/16/2014 yST 0Tµ X1 ToRY�a 1 ER E.L EACHACCIDEVT $ 100,000 $ 100,000 E.L DISEASE - EA EMPLOYEE EL. DISEASE - POLICY UNIT $ 500,000 DES IPRCN OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Attritional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE BUILDING DEPT 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 SHOULD AN Y OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AunioP1zED REPRESENTATIVE X76 lam ff.A. • ACORD 25 (2009/09) © 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AC# 6236767 ran not A e-• n e+ O.% ■ w ■-•-a i ■ i► r. • rDOC,jr All ■w•t ••maw A a a wow. Am. . -.. •••• otom BACKGROUi A,' '.MICRoPRINTIWG„► Eitt{AF ENT D P TOR STATE OF FLORIDA DEPARTMENT ••OF BUSINESS.. AND PROFESSIONAL REGULATION CONSTRUCTIQ• I•DTJSTRY LICENSING BOARD SEQ #L12073102047 DATE :BATCH NUMBER. LICENSE NBR 07/31/2.012 .12.003067.9..CFCO27526• The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter:: Expiration date: AUG 31, 2014 . WILKINSON, LANCE A -1 QUALITY .PLUMBING CORP 1055 NW 31ST AVE POMPANO BEACH FL 33069 pTry grnmm BROWARD 115 Business Name: Owner Name: Business Location: Business Phone: Rooms COUNTY LOCAL BUSINESS TAX RECEIPT S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954 - 831 -4000 VALID OCTOBER 1, 2012 THROUGH SEPTEMBER 30, 2013 DBA:A 1 QUALITY PLUMBING CORP Receip##:PSU2MBING/LWN Business Type: (CERTIFIED PAT WILKINSON LANCE Business Opened:03 /07/1988 1055 NW 31 AVE StatelCounty /Cert/Reg:cFCO27526 POMPANO BEACH Exemption Code: 954 -346 -8500 Seats Employees Machines Professionals 1 SPRNKL /CONT• PLUMBING CONT• 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 WHEN VALIDATED 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: PAT WILKINSON LANCE Receipt #01A -11- 00010048 1055 NW 31ST AVE Paid 08/15/2012 27.00 POMPANO BEACH, FL 33069 -1107 2012 - 2013 AC# 6236767 ran not A e-• n e+ O.% ■ w ■-•-a i ■ i► r. • rDOC,jr All ■w•t ••maw A a a wow. Am. . -.. •••• otom BACKGROUi A,' '.MICRoPRINTIWG„► Eitt{AF ENT D P TOR STATE OF FLORIDA DEPARTMENT ••OF BUSINESS.. AND PROFESSIONAL REGULATION CONSTRUCTIQ• I•DTJSTRY LICENSING BOARD SEQ #L12073102047 DATE :BATCH NUMBER. LICENSE NBR 07/31/2.012 .12.003067.9..CFCO27526• The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter:: Expiration date: AUG 31, 2014 . WILKINSON, LANCE A -1 QUALITY .PLUMBING CORP 1055 NW 31ST AVE POMPANO BEACH FL 33069 pTry grnmm Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 CG 135 2' Inspection Number: INSP - 187915 Permit Number: ELC -3 -13 -573 Scheduled Inspection Date: May 16, 2013 Inspector: Devaney, Michael Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Renne M. Hall Miami Shores, FL 33138 -0000 Project: BARRY UNIVERSITY Contractor: ELECTROCOM INC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1121360010160 -18 Phone: (954)632 -1091 Building Department Comments REPLACE RECEPTACLES WHERE NEEDED Infractio 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 &/6°;1 e4' May 15, 2013 For Inspections please call: (305)762 -4949 Page 7 of 38 f 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 2010 Permit No. C ) 5-3D Master Permit No. Permit Type: Electrical JOB ADDRESS: I I3OC) ►'E 2—'d ave City: Miami Shores County: Miami Dade Zip: _ 1(o 1 Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): rrij f I Pit �P_ r� I Phone#: Address: II ?cc CYE 9cd p1✓e City: (Vl irerfl i Ohnrec> State: -riorridct Zip: F1 (D Tenant/Lessee Name: 0/1421- Phone #: Email: CONTRACTOR: Company Name: �- �� "We" Phone #: 9CV Z-24, Z- %d 12/ Address: , *eel ,4 City: 71 State: ,( Zip: 5') Qualifier Name: . Phone#: State Certification or Registration #: /Go' /� Certificate of Competency #: I / ®62 Z Contact Phone #: Email Address: 7,4,91,;14/4"/ e 4- 11. DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ aet:) • c'C) Square/Linear Footage of Work: Type of Work: ❑Address Description of Work: DAlteration ONew DRepair/Replace ODemolition *+ x**+ x****** **** **+ x******a :************** Fees**** *****+ n**+ x*x: ****x: ************************ Submittal Fee $ Permit Fee $ /1-23° "'4'4';" 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 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 apprj and a reinspection fee will be charged. Signature — Signatures /ham . T Owner or Agent The foregoing instrument was acknowledged before me this day offs {. , 20 I Zv , by kid WV/gar who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission APPROVED BY Contractor 9_61n The fo> going instrument was acknowledged before me this day of if.nrire IA, 20 j, by l'►r►°* erkj ,,-_.trth L 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: *x: *x:**** ** * ** * * * * ** ** * * * ** *** * * * ** * * **** /''- Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10/2009)(Revised 3/15/09) "rpm °o•. Kimberly Stahl `?tACOMMISSION #EE1696,90 EXPIRES3 FEEL 18, 2015 mom * * * *.. *** ***** Zoning Clerk 2013 - 03-22 18:ls ACURt ELECTROCOM 9545788151» 1 800 685 7530 CERTIFICATE OF LIABILITY INSURANCE P 2/2 ELECT -4 OP ID: AM DATE(MMsDD1YYYY) 11/07/12 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIOHTS UPON THE CERTIFICATE HOLDER. THIS GERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATtvELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING; INSUREIt(B), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: H the certificate folder is an ADDITIONAL INSURED, the poficytles) must be endorsed. If SUHttOGATION 18 WAIVED, subject to the terms and conditions of the policy, certain polities may require an endorsement, A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsementtsj. PRODUCER W.F. Roemer Insurance Agency 4752 W. Canmercial Blvd Fort Lauderdale, FL 33319 Jonathan F. Remes 954731.5568 ii°al"d5 954-731-8438 FwoH°I, jhz E-MAIL ADDRESS Law INSURED Electrocom, Inc. 8531 NW 46 Court Lauderhill, FL 33351 INSURER(S) AFFORDING COVERAGE INSURER A ;A soCIatiOn Insurance Co. INSURER u Travelers NATO V 11240 25858 INSURER c:Com merce & Industry Ins. Co. INSURER 19410 INSURER. B: COVERAGES CERTIFICATE 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 CONDMON 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. TYPE OF INSURANCE ADDL. w= tseucYNUMBER POLICY E t1AAilbn)Ywn LIMITS GENERAL X LIABILITY COMMERCIAL GENERAL LIABILf1Y 16802460P687TIL12 11/09/12 11/08113 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PnEMISES occurrer ca) $ 300,000 CLAIMS.MADE X occua MEDD EXP (Any one pieson) $ 10,000 PERSONAL & ACV INJURY S 1,000,000 GENERAL AouRkuAtS S .•2,000,000 _- GENT. AGGREGATE LIMIT APPLIES PER POLIO/ X ..w LOC PRODUCTS . COMP /OP AGO $ 2,000,000 Y $ AUTOMOBILE = — LIABILITY ANY AUTO AUTOS OWNED HIRED AUTOS UTOSSULtsf NONpy a EP AUTOS CIA@ ' ' ` •L s R (Ea accident) •• BODILY INJURY (Pet pelmon) -� $ BODILY INJURY (PSrgcddant) $ P12.1411 a AGP $ C X UMBRELLA LIAR EXCESS LAP X OCCUR CLAIMS-MADE 88U024044672 0011/12 06/11/12 EACH OCCURRENCE $ 1,000,000 AGGREGATE a 1,000,000 A WORRERSCOMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNEWEXECuIWE Y / N CPRCER/MEM$ R E XXLUOE04 (Mandatory to NN) tIyag ' IQM+�a under ) PTH3N OF RATIONS *Mow _ N I A WCV007627003 11116112 11/18/13 x TWORGYSTf'ATU- T H- S.L. EACH ACCIDENT $ 1,000,000 E L DISEASE • SA EMPLOYEE S 1,000,000 EL. DISEASE • POLICY LI if 1 000,000 mammas Cr OPERATIONS! LOCATIONS ) VEHICLES (Attach ACORD 1C H, M dltbr$I RamaxkI SaMMI A, E more apace Is raqudnd) MIAMIS2 Village of Miami Shores 10050 NE 2 Ave. Miami Shores, FL33138 SHOULD ANY OF TN8 ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIMTIDN SATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATWE AGOrlD 20 tZ010I00) ®10882010 ACORD CORPORATION. All rights reserved. Tl.s ACOraD non. and Man f ro T aILtorod marks of ACORD 2013 -03-22 18:20 w ELECTROCOM 9545788151>> 1 800 685 7530 P111 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 WEBB, GARFIELD S ELECTROCOM INC 8531 NW 46 CT LAUDERHILL FL 33351 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.myflorldalicense.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 licenser AC# 6341969 DETACH HERE STATE OF FLORIDA AC# 634i96q DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ER13014351 09/06/12 128071450 REG ELECTRICAL •C WEBB, GARFIELD SONTRACTOR ( ELECTROCOM INC (INDIVIDUAL LICENSING ESQ ITRTS PRIOR TO CONTRACTING IN ANY AREA) RAS R,1GISTIR D under the proviaions of Oh.409 saptzarsrm ease, AUG 31, 2014 L12090601896 • Tf115 r)QC: 1101-1!T IIAS A COI ,.O EL) UACKC;R()IJNii • MICIiOPItINTING • LINEMARK' PATENTED PAPER p STATE OFF FLORIDA PROFESSIONAL DEP � TRICALSGOONNTRACTORSRLICENSING BOARD TION SEQ#L12090601896 DATE`: EATUI NUMULI. LICENSE NCR _09106/2012 128071450 ER13014351 The ELECTRICAL CONTRACTOR Named below HAS REGISTERED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 (INDIVIDUAL MUST MEET ALL LOCAL LICENSING REQUIREMENTS PRIOR TO CONTRACTING IN ANY. AREA) WEBB, GARFIELD S ELECTROCOM INC 9531 NW 46 CT LAUDERHILL FL 33351 RICK SCOTT ZEN_ L?MSON ELECTROCOM 9545788151» 1 800 685 7530 P112 MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAQLER ST. 1st FLOOR MIAMI, FL 33130 2011 LOCAL. BUSINESS TAX RECEIPT 2012 FIRST-CLASS MIAMI-DADE COUNTY - STATE OF FLORIDA U.S. POSTAGE EXPIRES SEPT. 30, 2012 PAID . . MUST Be DISPLAYED AT PLACE OF BUSINESS MIAMI, FL PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 PERMIT NO. 291 684723-1 THI,' IS NO! A BILL DO NOT PAY NEW Bu �g f011Ei OC � �N cc 1�E9Iriti�f0257 712144 -5 F DOING BUS IN DADE CO QWgICTROCOM INC seeiTlgettrefricAL CONTRACTOR THIS IS ONLY A Lo •AI. 6USINESR TAX N6C#R''Y. 11 fllXS NOI PERMIT THE Ili) UP A TO VIOLATE ANY r)ISTINC RECULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQIIRED BY LAW. THIS IS NOT A CERTIFICATION OF Mr. HOLDER'S OUALIFICA. NONR, PAYMENT RECEIVED MIAMI•DAPC GOON RECEIVED TAk GUl.IMCTOR: 60000000503 000150.00 SEE OTHER SIDE WORKER /S 1 DO NOT FORWARD ELECTROCOM INC GARFIELD WEBB PRES 8531 NW 46 CT LAUDERHILL FL 33351 1,1111 „111,1111,1,1, I 1 11,1 11111,11,11,1,1 111, IL I 1 11,11 Ago • Construction T T Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 11 E000257 ELECTROCOM INC D.B.A.: GARFIELD Is certified under the provision of Chapter 10 of Mlami -Dade County VALID FOR CONTRACTING UNTIL 09/30/2013 2013 -03-23 14 ;36 ELECTROCOM 9545788151» 1 800 685 7530 THIS IS NOT A BILL — DO NOT PAY RECEIPT NO. 30- 7121445 CC NO; 11E000257 BUSINESS NAME / LOCATION ELECTROCOM INC DOING BUS IN DADE CO OWNER ;ELECTROCOM INC SEE BACK OF RECEIPT FOR A LIST OF NON — PARTICIPATING MUNICIPALITIES Receipt holder must register In the alter where work Is to be done. PAYMENT RECEIVED raAMI -DADS COUNTY TAX COLLECTOR 01/08/2013 02260001001 000E00.00 I MIAMI -DADE COUNTY 4400 F COLLECTOR ST. M� FLOOR U.S, POSTAGE PAID MIAMI, FL PERMIT NO. 231 RECEIPT HOLDER MAY DO BUSINESS AS A CONTRACTOR AS SPECIFIED HEREON. ELECTRICAL CONTRACTOR DO NOT FORWARD ELECTROCOM INC ©ARFIELD WEBB PRES 8531 NW 46 CT LAUDERHILL FL 33351 L'LI'h1' 11P11 1i�Il�iL� #jii1Illl1i'1'11II'I'1'II{ II1'i'1L }I6 68�4722g3�- -E1Lp �gyyp BUSIN E.TRUCUM CINGN �L DDIN8 BUS IN DADE CO 2011 LOCAL BUSINESS TAX RECEIPT 2012 MIAMI -DADE COUNTY - STATE OF FLORIDA RES SEPT. MUST BE DISPPLA P D AT LACE OF BUSINESS PURSUANT TO COUNTY 000E CHAPTER SA - ART. 9 a 10 THIS IS NOT A BILL — DO NOT PAY NEW CC E° ' �t 0 257 oWtLECTROCOM INC seclTAe erelitri CAL THIS IS ONLY A ELOCAL ISOMERS B NOT TAX TILE HOLDER TO VIOLATE ANT UNTY REGULATORY NTOHR E ZOHNO LAWS OF R WERRON mPE FROM ANY OTHER PERMIT OR R LICENSE ENSE S! 5oos= By LAW. THIS is T A CERTIRCATION OF THE HOLDER'S OUALIRCA. tPAVNEN �C Tq g CT� LINTY TAX 60000000503 000150.00 SEE OTHER SIDE CONTRACTOR WORKER /S 1 DO NOT FORWARD ELECTROCOM INC GARFIELD WEBB PRES 8531 NW 46 CT LAUDERHILL FL 33351 illiii.,1in.11..111►If11111►1► 11►111ad„1►111►►►1i1 ►11� FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 712144 -5 P 1/1 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) 762.494 BUILDING PERMIT APPLICATION RECEIVE Z, MAY 142 FBC 20 Permit No. Master Permit No. l3 Permit Type: BUILDING ROOFING S JOB ADDRESS: 1 r �C C) f 1E. 2t6 1° e stunt i' Y. -1--let LL Z itiffit City: Miami Shores County: Miami Dade Zip: .515155 315 Folio/Parcel#: 1 12.13(o Qb 161 top - 1 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Yrl j ( lfyv - r5t4y Phone#: Address: 1 L LX t€ 2:6 ove City: ) i('11-0 3 )tr -, State: r 1.. zip: 331.8 'C)b 0 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: (Pj Phone #: l")' -- - (o Address: 1;759 c) 2A City: State: I Zip: Qualifier Name: OlrXlt le 1 ( ' tern )e-s Phone#: State Certification or Registration #: CA L. 151 194-6 Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 11..F11.)0, o® Square/Linear Footage of Work: Type of Work: °Addition °Alteration New 'epair/Replace Description of Work: t a► Z - 2 * ®a r NMI aaV 1II& 11161111111M111111 mil fir °Demolition Color thru tile: * * * * * * * * **** * ************** **** ***** *F * * *** ova ** **** *** * *,x****** ** ***i* * *** *vow * ***• Submittal Fee $ Permit Fee $ J CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 4 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 Fi.F,CTRICAL 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 approved and a reinspection fee will be charged. Signature Owner or Agent (6� The foregoing instrument was acknowledged before me this day of Pay , 20 a, by aiNC6 O.1441C-r who is personally known to me or who has produced As identification and who did take an oath. NOTA : PUBLIC: Sign. Print: My Commission Expires. Signature, Contractor The foregoing instrument was acknowledged before me this 54-- day of 4 _ , 20 /2_, by 64,1 ain®�aCt 1 C , who is person • y own to me or who has produced as identification and who did take an oath. NOTAR P 13, L. mb ply hl MISSION #`EE 169880 v 94� ":taIRES: FEB.15, 2015 Sign: Print: Q -e �. l c, r� k` My Commission Expires: s f rt ****** *****+x+x******** **+x** ************************* ** * * *** * **** * **** * * ** ***** * **** x****************a *** * **** APPROVED BY�`� Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk 141 (In e unA 2_ 1*/)\oovr) C ni Is et) li.Tr-e 7-Otte_ A- tiJA-tor- uc.,rn,f) t trtt)t %\tple.,ce WA) PERMT #: "35 Miami Shores Village APPROVED ZONING DEPT BLDG DEPT BY DATE ;z770-47 SUBJECT 10 CONIPIVNCE WI ALL FEDERAL STATE AN C(jUN 7 FILLS AND REGULATIONS