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ELC-13-1202Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 193737 Permit Number: ELC -5 -13 -1202 Scheduled Inspection Date: June 18, 2013 Inspector: Devaney, Michael Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Powers Building Miami Shores, FL 33138 -0000 Project BARRY UNIVERSITY Contractor: TRI -CITY ELECTRIC CO INC Permit Type: Electrical - Commercial Inspection Type: l h Work Classification: Addition /Alteration Phone Number Parcel Number 1121360010160 -20 Phone: (305)642 -5428 Building Department Comments INSTALL 3 Receptacles 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 &/•/;0' fa7/e June 18, 2013 For Inspections please call: (305)762 -4949 Page 22 of 25 Miami Shores Village McmEwx 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 Permit Type: Electrical FBC 20 w.o..0100o Permit No. !—L / /EYE 0o2 Master Permit No. JOB ADDRESS: P 1 WIVwc PUwrAS #07 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): RAW UNlVv Sent Phone #: Address: I l 3Oo SAI4 AV E7 E7 City: I v r 1 AkM State: / zip:3 137 Tenant/Lessee Name: Phone #: Email: CONTRACTOR: Company Name TY1 €C.'f1 C Ci Phone #: Q 61-1Q6 Address: l.P's f &) Ikikt■ City: tCLiY1a State: ROY761.6--- Qualifier Name: Dal rc eel Tr. State Certification or Registration #: `3 Certificate of Competency #: Contact Phone#: Email Address: DESIGNER: Architect/Engineer: Phone#: Zip: J -3Q5 Phone #: A 514°Q& Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: Address ❑Alteration New ORepair/Replace Description of Work: TIVICat recce(- es t "fn —P r () UDemolition ****** *m ** ********* **************** Fees***************** * **** * * *****m*** * ** * * *** * ** Submittal Fee $ Permit Fee $ /1-6 aettF CCF $ CO /CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $_Lf 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 approve, d a reinspection fee will be charged. Signature Owner or Agent The foregoing instrument was acknowledged before me this day of Al , 20 G, by WM, Pimetiatar , day of The foregoing instrument was acknowledged before me this ,20_,by who is personally known to me or who has produced As identification and who did take an oath. NOTARY P, . ; LIC: My Commission Expires: L1 who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Print: My Commission * ********* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Zm /,17 t/N4 V Plans Examiner Structural Review (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) °', Debra Public stela of Flpri� Debra B Oamera ►n * xpires 7 $4 m e * * ** Clerk DETACH HERE , This boculiwNT. HAS A COLORED.BAPKGROUND. MICROPRINTINO ,....INEIVIARK"PATENTED PAPER. C# 6.228741 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD SEQ# L12072601472 DATE BATCH NUMBER LICENSE NBR 07/26/2012 128001677 EC0000136 The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2014 BORDEN, DILLARD R JR TRI-CITY ELECTRIC CO INC 13627 DEERING BAY DR UNIT 903 CORAL GABLES RICK SCOTT . GOVERNOR FL 33158 •. i KEN LAWSON SECRETARY '4'�°, -R °® CERTIFICATE OF LIABILITY INSURANCE DATE i o� ) 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(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 lieu of such endorsement(s). PRODUCER Keen Battle Mead & Company 7850 Northwest 146 Street Suite 200 Miami Lakes FL 33016 CONTACT NAME: PHONE r ), 305.558.1101 FAX No). 305.822.4722' ADDRESS: PRODUCER CUSTOMER ID 8: INSURER(S) AFFORDING COVERAGE NAM # INSURED Tri -City Electric Company, Inc 625 NW 16th Avenue Miami FL 331254611 INSURERA:Travelers Indemnity Co of Amer LIABILITY X INSURERB:Charter Oak Fire Ins Co INSURERC:Travelers Prop Cas Co of Amer C03664P993TIA12 INsuP:ERD:Bridgefield Employers Ins Co /2013 INSURER E :AGCS Marine $ 1,000,000 INSURER F: DAMAGE TO RENTED PREMISES (Ea occurrence) COVERAGES CERTIFICATE NUMBER:12 -13 GL /BA /UME /WC /IM 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 TYPE OF INSURANCE IN R SUBR POLICY NUMBER (MM/DD/YYYY) (MNWD/YYY) LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY X OCCUR C03664P993TIA12 07/01/201207/01 /2013 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED PREMISES (Ea occurrence) 300,000 $ CLAIMS -MADE _ MED EXP (Any one person) $ 5, 000 X Blkt Contractual PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L 7 AGGREGATE LIMIT APPLIES PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X JECT $ B AUTOMOBILELIABILIY X X X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 8103664P993C0F12 07/01/201207/01 /2013 COMBINEDSINGLEUMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ C UMBRELLA LAB EXCESS LIAB X OCCUR CLAIMS -MADE CUP3664P993TI1,12 07/01/201207/01 /2013 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 X DEDUCTIBLE RETENTION $ 10,000 $ $ D WORKERS COMPENSATION AND EMPLOYERS' LWBILnY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) DEG RIePsTaIiO uOnFeOr PERATIONSbelow Y / N N/A 083045364 07/01/2012 07/01/2013 y WCSTATU- OTH- TORY LIMITS ER EL EACH ACCIDENT $ 1, 000, 000 EL DISEASE - EA EMPLOYEE $ 1,000,000 EL DISEASE - POUCY LIMIT $ 1,000,000 E Inland Marine M2I93021023 07/01/201207/01 /2013 $100,000 Leased /Rented Equip $2,500 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) CERTIFICATE HOLDER CANCELLATION Miami Shores Village Building Department 10050 N.E. 2nd Ave 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 Alex Perez /JMC ACORD 25 (2009/09) INS025 (200909) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i ! *"" MIAMI•DADE COUNTY • • '• TAX COLLECTOR • 140 W. FLAGLER Si; lit FLOOR' • MIAMI, FL 33130 026651-0 BUSINESS NAME1 LOC_ATION TRI CITY ELECTRIC CO INC 625 NW 16 AVE 33125 MIAMI 2012, LOCAL BUSINESS FAX RECEIPT 2013 : MIAMI7DADE COUNTY-. STATECF FLORIDA EXPIRES.SEPT. •ck 2013 ' MUST BE,O1SPLAYE0 AT PLACE OF BUSINESS PURSUANT TO COUNTY-CODE CHAPTER SA - ART. 9 & 10 THIS IS NOT A BILL - 00 INOT PAY OWNER TRI CITY ELECTRIC CO INC Secirat Business ELECTRICAL CONTRACTOR TIM II ONLY A LOCAL NESS TAX RECEIPT MEE ROT PERMIT THE HOLDER TO VIOLATE MT Emus necasatifer OR WOO LAWS OP THE COMM O WIEEL NOR DOES IT EXEMPT fl MOLDER PRDMANY OTHER PEFOET MT LICENSE REQUIRED BY LAW. 1116 NOT A CERTIEWATIOR OF ME HOLDER'S 4TUAUFMA- TM& mnierrItcomen. Mummecommwm Coummft '08/16/2012 600100 00459 000135.00 RENEWAL STATES REC0_PAPT 050136 NO. 026651-0 EC FIRST-CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 WORKER/S 40 00NOTFORINARD TRI CITY ELECTRIC CO INC D R BORDEN JR 625 NW 16 AVE MIAMI FL 33125 inilvanALJJ4JuhdAJ.MWOJiLdiat LE:0ti £T02 90 -Nnf s02:w0Jd T'Z:a6Pd