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PW-14-1251 (2)Inspection Worksheet - Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-218085 Scheduled Inspection Date: August 20, 2014 Inspector: Rodriguez, Jorge Owner: SCHOOL INC, MIAMI COUNTRY DAY Job Address: 10653 NE 6 Avenue Miami Shores, FL 33138 - Project: <NONE> Contractor: US BRICK & BLOCK SYSTEMS eunaing uepartment comments PAVER REPAIR Permit Number: PW -6-14-1251 Permit Type: Public Works Inspection Type: Final Work Classification: Public Works Phone Number (305)759-2843 Parcel Number 1122310120010 INSPECTOR COMMENTS False Phone: 954-792-0076 Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-217780. CREATED AS REINSPECTION FOR INSP-217231. CREATED AS REINSPECTION FOR INSP-214179. Inspection not called fo Finish/ landscaping, Failed Called contact number at 1:00 PM No permit on site CALL MIKE CABAN 305-206-1761 Correction ❑ Needed OR GARRY BUTTS 305-613-6451 Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. August 19, 2014 For Inspections please call: (305)762-4949 Page 17 of 26 "! - 7T—)- Miami Shores Village -77"T,17 JUN 8 2014 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 20 BUILDING Master Permit No1� P 124S f PERMIT APPLICATION Sub Permit No. 0 BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑ RENEWAL ❑PLUMBING ❑ MECHANICAL UBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP iILD i �z (,C;;,A,,, CONTRACTOR DRAWINGS JOB ADDRESS: 601 10 th Street, Miami Shores, FL 33161 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:3022310240050 Is the Building Historically Designated: Yes NO No Occupancy Type: EDU Load: Construction Type: Paver Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Miami Country Day School, Inc. Phone#: (305) 779-7319 AAA-- 601 107th Street City: Miami Shores Tenant/Lessee Name: Email: State: Florida Zip: 33161 CONTRACTOR: Company Name: US Brick & Block Systems, Inc. Phone#: (305) 888-3000 Address: 1800 NW 22nd Street City: Fort Lauderdale State: Florida Zip: 33311 Qualifier Name: James Scott Bond Phone#: (305) 888-3000 State Certification or Registration #: CGCO50885 Certificate of Competency M DESIGNER: Architect/Engineer: Kimley Horn & Associates, Inc. Phone#: (305) 673-2025 Address: 1691 Michigan Avenue City: Miami Beach state: FL Zip: 33139 Value of Work for this Permit: $ 108,000 Square/Linear Footage of Work: 30,000 sq. feet Type of Work: ❑ Addition ❑ Description of Work: Paver Repair Alteration ❑ New ■❑ Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ C Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) N/A 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 charaed. i Signature OWNER or AGENT The foregoing instru t was acknowledged before me this /0 day of Ude- 20 , by who is personally known to me or who has produced as identification and who did take an. oath. NOTARY PUBLIC: Print: Seal: :' My Comm. Expires Feb 28, 2017 %r9, GeV Commission # EE 849356 Bonded Through National Notary. Assn. Signature . , -,z '4 CONTRACTOR The foregoing instrument was acknowledged before me this day of au me— , 20 \-t , by s ,'awe S &,u A , who is personally known to me or who has produced f as identification and who did take an oath. NOTARY PUBLIC: Sign:44. Print: Seal: JULIE ANNEITE IMMERMAN ********IRV fids z'►s�p;o?;,•° EXPIRES Marc (ao7) 389 Otb3 FloridallotaryServlce.com APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revisedo2/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 •� 1940 NORTH MONROE STREET ,arc*`• TALLAHASSEE PL 32399-0783 SOLD, JAMES SCOTT IIS BRICK'& BLOCK SYSTEMS LLC 1800 NW 22 STREET FT LAUDERDALE. FL 33311 Congratulatlonsl With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professlonal Ragulatl Our professionals and businesses range from architects to yacht brokers, froi 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 For information about our services, please log onto www.morldallcense.c There you can find more Information about our divisions an the regulations 1 Impact you, subscribe to department newsletters and team 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 11c+ DETACH - THIS DOCUML-NT HAS A COLORED RACKGROIlND • MICROP_RINTING • LP1EAAAAW' PATS 'Z+ ` !i= •` V. I"t'� - _ _ �'-8 . 7, T'e�' •: g7;- 112; 7;'' . : ie'<.: 'l' i; _x.' -i: i ."�Si'•• i. ,'} 'i :N : .'�. •'� - �;••J�' i lie: .�H.+•ap,,'•'�:,�„e�. :�":..ay �:.y�'�•1:"- �v:'' �Y' P=ti • 8,. �^ r..�• ' Lir Y ''.v i f,:, ..... r :{s a- ;' y"=•" : } t -i!' ?L:'� I ! :' _"!`.dies•-3`•.L=1-4.gi, t. ...; Qr :'?!`^ - '�. 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"::..'K'ir:.:j;;!;.�._ .a_a, i.�-'.•- - -,�''' ...h•.•.::s • ':':iw:�':r - - - `'' QISi�7f AS 'RLE�UI[�EDrF3'1�-L,e►W - 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale-, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2013 THROUGH SEPTEMBER 30, 2014 Dek. Recalpt*189-41S2 U 8 BRICK & BLOCK SYSTEMS LLC AM OTM TYPES Business Name: Business Type:313 MINOR ROADS 0 Owner Name: JAMw s BoND/QuAL Business Opened:lo/03/1990 Business Location: 1800 NW 22 STREET SUte/CountylCert/Regm-1220 FT LAUDERDALE Exemption Code: Business Phone: 954-792-0076 Room tieats..: JEM "s ...4646inn Profmiaraft For Vending Sushms Only Number of Machines: Tax Amount I Transfer Fee N.;kFF"., _.Fefioft Ypprs CoftectionCast -1- Total Paid 54.001 0.00 0.06J.. 5.4400.. 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 to non -regulatory In nature. You must meet all County andior Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, busineos name has changed or you have moved the business location. This reoelpt does not Indicate that the business le -legal or that it Is in compliance with State or local laws and regulations. Mailing Address: U S BRICK & BLOCK SYSTEMS LLC 1800 NN 22 STREET FORT LAUDERDALE, FL 33311 2013 -2014 Receipt #139-12-00010132 Paid 07/11/2013 $4.00 (Sac BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2013' THROUGH SEPTEMBER 30, 2014 DBA: U S BRICK & BLOCK SYSTEMS LLC Receipt #:��79COWMC>i0R (W Business Name: Business Type:cONTRACTOa,) Owner Name: JAMES S BOND Business Opened:11/30/2001 Business Location; 2800 NK 22 ST State/County/Cert/Reg:CGC050885 FT LAUDERDALE Exemption Code: Business Phone: 954-791�:00716• . Rooms soots Emptoys ;Maahtnes Profesatone Number of Uachlnes: Vending Ty Ise: Tax Amount Transfer F� '` N$F'i?ee F?enalijR < PiiQrYear: rCollectlon Cosi Total Paid 27.00 0.00:; :p:.;.pQa >'p.:00b `•':.. ...:.O,Ofl.'. ;: 4.00 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 VAUDATED and zoning requirements. This Business Tax Receipt must be transWred when the business is sold, business name has changed or you have moved the business location. This r ecelpt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: U S BRICK & BLOCK SYSTEMS LLC 1800 NW 22 ST FORT LAUDERDALE, FL 33311 2013 .2014 Receipt #031-12-00002304 Paid 07/10/2013 27.00 May 30, 2014 Miami Shores Village Building Department uINr:T ti Iirl DANIEL R. KOFFSKY Principal 4040 ME: Second Avenue Tel. (305] 573,2626 Suite 305 Fax (305) 573.2620 Miami, Florida 33137 Cell (305] 433-7776 Email. Dan@skylinemgmtcam RE: 601 NE 107th Street, Miami, FL 33161 To Whom It May Concern: Mr. Gary Butts, Chief Operations Officer, is an authorized signer on behalf of the corporation, Miami Country Day School, Inc., owner of the above addressed property. Sincerely, clo� UVU4k Anne Paulk, President Board of Trustees Miami Country Day School, Inc. $HELLIE L. FULFORO Notary Public - State of Florida •: My COMM. Expires Feb 28.2017 Commission # EE 849356 '' ° �••� BondedThrough Nationhl NobryAssn. 601 Northeast 107 Street I Miami, Florida 33161 1 305.779.7200 1 www.miamicountryday.org 75 years. It's only the beginning. A'C<>aCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY10 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, §Z13 2014 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 pollcypes) 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 Bateman Gordon and Sands 3050 North Federal H Lighthouse Point FL 33064 CONTACT PHONE FAX c N°' " E-MAILDS: INSURER AFFORDING COVERAGE NAIC # LIMITS INSURER A:First Mercury Insurance Company 10657 GENERAL LIABILITY INSURED USBR12 INSURER B .WeSCO Insurance Company 25011 INSURER C:Evanston Insurance Company U.S. Brick & Block Systems, LLC 1800 NW 22 Street /10/2015 Fort Lauderdale FL 33311 INSURER D X COMMERCIAL GENERAL LIABILITY INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 16147751A7 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. ILTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICYEFF MPOLICY/ EXP LIMITS A GENERAL LIABILITY Y NJCGL000002835702 /10/2014 /10/2015 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY (RENTS en $50,000 MES CLPJMS-MADE a OCCUR MED EXP (Any one rson $EXCLUDED PERSONAL&ADV INJURY $1,000,000 X 5,000 X XCU/Contractual GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 $ POLICY X PECTRO LOC B AUTOMOBILE LIA2ILRYWPP111515600 /4/2013 /4/2014 Ea accident) LIMIT SINGLE $1,000,000 BODILY INJURY (Per person) $ X ANYAUTO A L OWNED SCHEDULED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident X NON -OWNED HIRED AUTOS X AUTOS C UMBRELLA LIABX OCCUR XOVA718114 /10/2014 /10/2015 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 X EXCESS LIAB CLAIMS -MADE DED I X I RETENTION 0 Underlying- GL ONLY $ WORKERS COMPENSATION WC STATUTORY I - OTH- AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? El N / A E.L. EACH ACCIDENT $ (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) Paver Permit & the CGC CGC Number CGCO50885 Certificate holder is an additional insured on General Liability coverage only when required by written contract, subject to terms, conditions, and exclusions of the policy. CERTIFICATE HOLDER CANCELLATION ©198&2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 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 Miami Shores Village ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVE Miami Shores FL 33138 AUTHORIZED REPRESENTATIVE rm ©198&2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AC40RDrCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYY1� 6/13/2014 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 pollcy(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 Jack Rice Insurance 13080 S Belcher Rd-DMAIL Largo FL 33773 CONTACT NAME: Commercial Lines Division PHONEWG No ga. (]2])530-0684 UVC. Noi: FAX (727)532-9602 SUBR INSURER AFFORDING COVERAGE NAIC @ INSURER AMrid efield Casualty Ins. Co. 10335 INSURED Modern Business Associates, Inc. ETAL L/C/F/ U.S. Brick & Block Systems, LLC 9455 Koger Blvd., Suite 200INSURER St. PetersburgFL 33702 INSURER S: INSURER C: INSURER D: E: INSURER F: COVERAGES CERTIFICATE NUMBER 0. S. Brick & Block 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 ADDL SUBR POLICY NUMBER POLICY EFF M D POLICY EXP M D LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE D OCCUR GE PREMISES Ea occurrence)$ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO JFCTLOC $ AUTOMOBILE LLABIL17Y COMBINED SINGLE LIMIT Ea ecoid, t BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOSAUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAS OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ A WORKERS COMPENSATION EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N/A 196-06932 1/1/2014 1/1/2015 WC STATUS —75TH - E.LEACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yS describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POUCY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Workers' Compensation coverage is provided by contract to all employees of Modern Business Associates, Inc. and its wholly owned subsidiaries assigned to U.S. Brick & Block Systems, LLC. Coverage does not apply to any employees not approved & assigned by Modern Business Associates, Inc. and its wholly owned subsidiaries, U.S. Brick & Block Systems, LLC, Effective 01/01/2014. City of Miami Shores 10050 Northeast 2nd Avenue Miami, FL 33138 ACORD 25 (2010/05) INS095 r9mnrim m 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 a Webster/LPW C ' fn ©1988-2010 ACORD CORPORATION. All rights reserved. Tho Annian nomo onel Innn orn ronleferoA morlre e+f Af`nRrl