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PLC-13-115007- 24 -'13 06;40 FROM- T -605 P0003/0013 F -759 Inspection Worksheet Miami Shores Village � 10050 N.E. 2nd Avenue Miami Shores, FL ) 11.� Phone: (306)795-2204 Fax: (305)756 -8972 Inspection Number: INSP - 192073 Permit Number: PLC -5 -13 -1150 Scheduled Inspection Date: July 23, 2013 Permit Type: Plumbing - Commercial Inspector: Diaz, Osvaldo Inspection Type: Final Owner: ,BARRY UNIVERSITY Work Classification: Addition /Alteration Job Address: 11300 NE 2 Avenue Flood Hall Miami Shores, FL 33138 -0000 Phone Number Project Parcel Number 1121360010160 -19 : BARRY UNIVERSITY Contractor: RIGHT WAY PLUMBING CO INC Phone: (954)423 -0000 Comments ALTERATION OF STUDENT RESTROOM IN FLOOD HALL I Intractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed Re- inspection ❑ Fee No Additional Inspections can he scheduled until re- inspection fee is paid. July 22, 2013 For Inspections please call: (305)762 -4949 Page 8 of 34 Miami Shores Village = Building Department AY 2 4 2013 . 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 20 % BUILDING Permit No. d 3 PERMIT APPLICATION Master Permit No. CC13 -1051 Permit Type: PLUMBING JOB ADDRESS: 11300 NE 2nd Avenue - Flood Hall City: Miami Shores County: Miami Dade gip; 33161 Folio/Parcel #: 11- 2136- 000 -0050 Is the Building Historically Designated: Yes NO X Flood Zone: OWNER: Name (Fee Simple Titleholder): Barry University Phone #: 305 - 899 -3050 AAA,.Pc�-11300 NE 2nd Avenue City: Miami Shores State: FL Tenant/lessee Name: Email: 33161 CONTRACTOR: Company Name: Right Way Plumbing Phone #: 954 -423 -0000 Address: 1329 Shotgun Road City: Sunrise -State: FL Zip: 33326 Qualifier Name: Daniel Rourke Phone #: 954- 423 -0000 State Certification or Registration #: CFC 045182 Certificate of Competency #: _ Contact Phone #: 305 - 987 -9411 Email Address: ►wP @rightwaypiumbing.com DESIGNER: Architect/Engineer: Cannon Design Phone#: 703 - 907 -2364 Value of Work for this Permit: $ 22,500.00 Square/Linear Footage of Work: Type of Work: ❑Address Q50/Alteration ONew ORepair/Replace ODemolition Description of Work: Alteration of student suite restrooms in Flood Hall Submittal Fee Scanning Fee $ Permit Fee $_ � �CCF $ CO /CC $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ - -- it Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State zip 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 approved and a reinspection fee will be charged. Signatur / Signa Owner or Agent Contractor The foregoing instrument was acknowledged before me this day of PJ'A- , 20 3—, by dGti L �R� F.-sN who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: e- Sip: Print:�� Notary Public State of Florida My Commission Expires: L4W Cheryl Balda Gerber ; @My Commiss on DD966126 Expires 05/08/2014 APPROVED BY The foregoing instrument was acknowledged before me this 16 day of May 20 L, by Daniel Rourke who is personally known to me or who has produced ' as identification and who did take an oath. /lans Examiner Structural Review (Revised3 /12/2012)(Revised 07 /10 107)(Revised 06 /10/2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: - -sett t4ard Print: Lissett 'ardo My Commission Expires: ,,` "Y "',a WSSEMFAPM pty CMMWO # EE 19WI EXPIRES: SepM W 9, 2016 Bonded Tlxe tlday PubHo l� �,k, kris, ksIs ,k�k�'RsR�skBsds,k�k8s�,ksk�iA , ,k,ks3s,k�k,k,k,R,ksRBs,ksk� Zoning Clerk ACC> CERTIFICATE OF LIABILITY INSURANCE ' DATE (MMIDDIYYYY) 6/28/2012 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). PRODUCER Seitlia 6700 N. Andrews Ave. CONTACT NAME: PHONN E : (954) 938 -8788 FAX No): (954) 938 -8566 E -MAIL ADDRESS: Suite 300 Ft. Lauderdale FL 33309 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Hartford Fire Insurance Co. 19682 • INSURED Right Way Plumbing Co. INSURER B: St. Paul Fire & Marine Ins. Co. 24767 INSURER C: Great American E &S Insurance 37532 INSURER D: DAMAF,F TO MEN IhU p EM SES Ea occurrence 1329 Shotgun Road INSURER E: $ 10,000 Sunrise FL 33326 -1935 INSURER F: X Contractual Liab. COVERAGES CERTIFICATE NUMBER: Cert in 33205 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 A UBR POLICY NUMBER POLICY EFF M/DD/YYY POLICY MMID LIMITS MIAMI FL 33147 GENERAL LIABILITY CH OCCURRENCE $ 11000,000 • X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR Y Y 21UMOR1683 7/1/20 7/1/2013 DAMAF,F TO MEN IhU p EM SES Ea occurrence $ 500,000 ED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 X Contractual Liab. GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea amidentl $ 11000,000 X BODILY INJURY (Per person) $ • ANY AUTO Y Y 21UMOK1684 7/1/2012 7/1/2013 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per acciden $ HIRED AUTOS NON -OWNED AUTOS • X UMBRELLA LIAB X OCCUR ZUP- 13507294 -12 -NF 7/1/2012 7/1/2013 EACH OCCURRENCE $ 10,000,000 X AGGREGATE $ 10, 000, 000 EXCESS LIAR CLAIMS -MADE DED I X I RETENTION$ Nil $ • WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNEWEXECUTIVE OFFICERIMEMBER EXCLUDED? El (Mandatory In NH) NIA Y 21WHOR1682 7/1/201 7/1/2013 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 11000,000 E.L DISEASE - EA EMPLOYEE $ 1,000,000 If yes describe under DESCRIPTION OF OPERATIONS be E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Pollution/ Prof. Liab. _l PCE262899503 1/8/2012 1/8/2013 Each Claim $ 1,000,000 Aggregate $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) PROOF OF INSURANCE ONLY. CERTIFICATE HOLDER CANCFI 1 ATInN ® 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF MIAMI SHORES 10050 NE 2ND AVENUE AUTHORIZED REPRESENTATIVE was MIAMI FL 33147 ® 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD