ELC-14-496Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
inspection Number: INSP- 208939 Permit Number: ELC- 3- 14-496
Inspection Date: April 04, 2014
Inspector: Devaney, Michael
Owner: , BARRY UNIVERSITY
Job Address: 11300 NE 2 Avenue O'laughlinHall
Miami Shores, FL 33138 -0000
Project: BARRY UNIVERSITY
Permit Type: Electrical - Commercial
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number
1121360010160 -30
Contractor: C.W. FISCHER ELECTRIC INC Phone: (954)566 -5689
Buildina Deaartment Comments
WIRE NEW RECEPTACLES IN CLASSROOMS FOR
PROJECTORS
Infractio Passed comments
INSPECTOR COMMENTS False
Passed
F-Tr
Inspector Comments
Failed
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
For Inspections please call: (305)762 -4949
April 03, 2014 Page 1 of 1
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Miami Shares 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
Permit Type: Electrical
FBC 20
rV
MA��4 �A14
Permit No.
Master Permit No.s-1
JOB ADDRESS: 11300 NE 2 AVENUE �Z q (r6 N L,1ll) _ L
City: Miami Shores County: Miami Dade Zip: 33161 -6628
Folio/Parcel #: 11- 2136 -000 -0050
Is the Building Historically Designated: Yes NO X Flood Zone:
OWNER: Name (Fee Simple Titleholder): BARRY COLLEGE Phone #:
Address: 11300 NE 2 AVENUE
City: MIAMI SHORES State: FLORIDA Zip: 33161 -6628
Tenant/Ussee Name: Phone #:
Email:
CONTRACTOR: Company Name: CW FISCHER ELECTRIC, INC. Phone#: 954 566 -5689
Address: 4057 NE 5 TERRACE
City: OAKLAND PARK State: FLORIDA Zip: 33334
Qualifier Name: CHARLES W FISCHER Phone#: 954 565 -8007
State Certification or Registration #: EC0001578 Certificate of Competency #: 3866694
Contact Phone#: 954 566 -5689 Email Address: ALISON @FISCHERELECTRIC.COM
DESIGNER: Architect/Engineer: NSA Phone #.
Value of Work for this Permit: $_ 66Z, 00 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition
Description of Work: WIRE NEW RECEPTACLES IN CLASSROOMS FOR PROJECTORS
Submittal Fee $ Permit Fee $ Z3 _e eta' CCF $ CO /CC $
r
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
s
Bonding Company's Name (if applicable) N/A
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable) N/A
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 approved and a reinspection fee will be charged.
S, ature�
_14 M .10 M''
Owner or Agent
The foregoing instrument was acknowledged before me this
day of P4XQ() , 20 !+, by ':;\A I
who is personally knows o me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign: - �1 V 11 t.)1
Print: UA L. (
My Commission Expires:
LORI L. CAJAS
My Comm. Expires May 30, 2014
Commission # DD 979550
Bonded Through National Notary Assn.
Contractor
The forego' g instrument was acknow�ge,before ma this
1,0 day of a" 20 L, by
o is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print: NOTARY PU9LIC
W1y ® F FLRIDA
My Comm m# EE12280
E�Ires 9/412015
APPROVED BY - g%L !�� 1'�
(� -' �/� Plans Examiner Zoning
Structural Review Clerk
(Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
t3 ea# fS.,U 0�1kMEe3'tfR�S 41a L --REi3 n, C.CGR, UifC? , 91 ROQRi,lTEi E� SINE ARECb' PRi EIITED FAPcRt � "� ..• i._e.,.
A # 6169981 STATE O FLORIDA
DEPARTMENT OF BUSINESS:AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
DATE - - LICENS- Z NBR
06/21/20121110439775 JECO001578
The ELECTRICAL CONTRACTOR
Named below IS CERTIFIED
Under the provisions of Chapter 489 FS.
Expiration date: AUG 31, 2014
FISCHER, CHARLES WILLIAM
C.W. FISCHER ELECTRIC, INC.
4057 NE 5 TERRACE
FT LAUDERDALE FL 33334
RICK SCOTT
GOVERNOR
-----------
4TATE OF FLORIDA AC# G&G998
-E
D,.PARTMENT OF BUSINESS AND
-PROFESSIONAL GULATION
Ec0001578 06/21/12 110439775
CERTIFIED ELECTRICAL CONTRACTOR
FISC&ER, CHARLES WILLIAM
C FISCHER ELECTRIC, INC.
3:S CERTIFIED Uld,, the p .. Jjoas or ch-489 Fs
-KPratLon date- AUG 31, 2014 L12062100937
MAILING ADDRESS
FISCHER ELECTRIC INC
CW FISCHER ELLECTIQ
4057 NE 5 TER :
OAKLAND PZM,
NAME AND L,OCAT4'ON OF LICENSED,
2013 -2014
ISSUED DATE: September 04, 2013
M
�1C�, NSE NUMBER
C W l+ "IS DER ELECTRIC, INC
TER ORIGINAL NUMBER 770��
OAKLAND PARK, FL 33334
LICENSE EXPIRES 9/3QIZ014
... 1 S Yi� ;.l !1 '. �i3A" 45- ✓ 1P: 1 �f ,. -.4.
"
't
THE PERSON OR FIRM. NAMED AB6VFF'IS HERFf4 , ICENSED TO ENGAGI+d IN THE I USINESS
I'I20FESSION OA , p ATION LISTEb BELOW IN THE CITY OF 'OAI�IAN A". �"LOiHDA.
BUSINESS CODE
BUSINESS DESCRIPTION
RESTRICTIONS
06470
ELECTRICAL CONTRACTORS
LICENSE MUST BE CONSPICUOUSLY POSTED AT THE PLACE OF BUSINESS SHOWN
i�
From: Gulfshore Insurance, Inc. To: Miami Shores Village Page: 212 Date: 3/14%2014 2:29:26 PM
Client #: 67981
CWFIS
ACORD,. CERTIFICATE OF LIABILITY INSURANCE
DATE(MM /DD /YYYY)
TYPE OF INSURANCE
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE �X
3/14/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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
Gulfshore Insurance - Naples
4100 Goodlette Road North
Naples, FL 34103 -3303.
NONNTA T Michelle A. Kalicharan
PHONE 239 435 -7143 FAX 239 213 -2852
A/c NO Ems' Arc, Ne
EooRess: mkalicharan @gulfshoreinsurance.com
INSURER(S) AFFORDING COVERAGE
NAIC #
239 261 -3646
INSURERA: National Trust Insurance Co
20141
INSURED C.W. Fischer Electric, Inc.
INSURERS: FCCI Insurance Company
10178
INSURER C:
4057 NE 5th Terrace
INSURER D:
Oakland Park, FL 33334
INSURER E:
$2,000,000
INSURER F:
RCVIOI%JM NYIY16CK:
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 CONTRACTOR 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
A
TYPE OF INSURANCE
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE �X
ADDL
INSR
UBR
WVD
POLICY NUMBER
GL0015410
AA�LDD /YYYY
5/22/2013
MMO /DIDIYYYY
05/22/2014.
LIMITS
EACH OCCURRENCE $1 000,000
PREMISES Ea occTuEnence
$ 300 000
MED EXP (Any one person)
$10,000
OCCUR
X PD Ded:500
ed:5 0
PERSONAL BADVINJURY
$1,00 000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PRO- LOC
PRODUCTS - COMP /OP AGG
s2,000,000
$
A
A
B
AUTOMOBILE LIABILITY
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
X HIRED AUTOS X NON-OWNED
RE
X rive OtlI Car
X UMBRELLA LIAB X OCCUR
EXCESS LIAR CLAIMS -MADE
NIA
CA0024259
UMB0016760
001 W C13A70643
512212013
5/22/2013
5/22/2013
05/22/201
05/22/201
05/22/201
COMBINED
Ea SINGLE LIMIT
accident
1,000,000
BODILY INJURY (Par person)
$
BODILY INJURY (Par accident)
$
PROPERTY DAMAGE
Per accident
$
EACH OCCURRENCE
$
$1,000,000
AGGREGATE
$1,000,000
DED X RETENTION 0
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER PE CCLUDED? ECUTNE
(Mandatory in NH) Eyl
It yes, describe under
DESCRIPTION OF OPERATIONS below
WC STATU- OTH- [TORY LIMIT
X
$
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE- EA EMPLOYEE
$1,000,000
E.L. DISEASE- POLICY LIMIT 1$1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
Electrical Contractor
CERTIFICATP wni nr-o _
Miami Shores Village
10050 NE 2nd Ave
Miami Shores, FL 33138
ACORD 25 (2010/05) 1 of 1
#S727203/M 650659
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
M
v .1 yeo -Zulu ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
MAK
0- 'W' Sliacker EIECiRIC. INC.
/mot t a..�►�. � I L.
C, l -S
i C-414-1
0' LA-VGKLIO Ff&t
Telephone (954) 566 -5689 • (954) 565 -8007
'/ "/y
Mom
MAR 4 2014
BY:
4057 Northeast 5th Terrace
Oakland Park, Florida 33334
/3/� AAC Colo l le-
1
G e i li r1'a�
shores Vill -age
SDF+B p1 6J B N
SY DATE
APPRO`,EO _ STATE Or F RIDA
D E P ( �- A-00 a G*nr o EE122W5
EvIr s of 5
BLDG DEPT
SUBJECT rO G�;PI I.i'�ICE Wl �l� Al L FEUERAL
STATE ANJ l:Ul ' � f iUL_S APlD REGULATIONS
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