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ELC-14-1201Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL cc Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-213870 Scheduled Inspection Date: November 13, 2014 Inspector: Devaney, Michael Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Cor Jesus Chape Miami Shores, FL 33138-0000 Project: BARRY UNIVERSITY Contractor: PROSTAR ELECTRICAL CONTRACTOR INC 13uiiaing uepanment comments Permit Number: ELC-6-14-1201 Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1121360010160-01 Phone: (786)307-4295 NEW CONCRETE RAMP AND DECK WITH CANOPY infractio Passed Comments CHAPEL BUILDING I INSPECTOR COMMENTS False Inspector Comments Passed EEr RALF 7862511331 Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. /Z�?p 4'11 ;ZAP /dy November 13, 2014 For Inspections please call: (305)762-4949 Page 4 of 45 w; Miami Shores Village Building Department JUN 062014 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. ,L-, PERMIT APPLICATION Master Permit No. cc l q - Z -,F 3 Permit Type: JOB ADDRESS: 113 0 © J j .Z AVE- 13AW UNIVEAS4,t C.&AEF.L City: Miami Shores County: Miami Dade Zip: 3 61 Folio/Parcel#: 112-136 0 0 1 0 1 6 0 Is the Building Historically Designated: Yes NO Zone: OWNER: Name (Fee Simple Titleholder):n &ay (%n) i yazsi ly Phone#: Address: I 1 '2 00 /� • `c' /Q i1 City: M, i <—' 6CXLJ_;75 State: fq - Zip: -3-316 Tenant/Lessee Name: Phone#: 3 ©,.r— ff9 9 7 9 L3 CRACTOR: Company Name* P"r c� �v L Cr' Jv c.cs� Phone#: ' ?6 ?)( YS State: ;L Zip: w ier Name: fV w %e !� r 4 t' D -+� Phone#: 7 h!`� 7 X11 c j :ertification or Registration # 6 6 !9 D p d LL s Certificate of Competency #: ;t Phone#: Email Address: JNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ a D U O ' o c� Square/Linear Footage of Work: d D 7— Type of Work: OAddress Alteration ONew ORepair/Replace ODemolition Description of Work:N`Et o A) c r2t"TE TR&� A� / W 0 0Ezm 1-f GA&I o fey 3 X-9 Submittal Fee $ Permit Fee CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ L Ll 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 whoseproperty 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. Sig Signature,,' -A Owner or Agent The foregoing instrument was acknowledged before me this day of 20 1�_, by Z49tj 120S6N'[QAU, , who is personally known to me or who has produced. As identification and who did take an oath. NOTARY PUBLIC: n nnnnnn Sign: "� JEFFRY J. YAO AMA Print: EXPIRES: Na�ember 12, 2014 r My Commission Expires: �� • - Contractor The foregoing instrument was acknowledged before me this,,?— day hisday of �20 N, byA m- crJNdU Leos who is personally known to me or who has produced as identification and who did take an oath. NOTARY Sign: Print: My Commission Rafael Huguet gXPkres 01 /2412015 APPROVED BY Aj�;�Ple- Af Plans Examiner Zoning Structural Review (Revised 3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk # 16 3 8 5 0 35: ST -ATE DF FLO tIDA, PROFSSSj N MV UTIONt4rONTMCTORS:ZlfMXWG AOA D SEQOL120920023-7 b§Y,2'oA0,4-i 1.1270-313A DATE(MMID CERTIFICATE OF LIABILITY INSURANCE 06/02l2014D 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 CONTACT Paychex Insurance Agency Inc NA PAYCHEX INSURANCE AGENCY, INC. 150 SAWGRASS DRIVE PHONE11, , 877-266-6850 FAX NO)n 585-389-7426 E-MAIL Certs@paychex.com ADD ESSffi ROCHESTER, NY 14620 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: NorGUARD Insurance Company 31470 INSURER B: PROSTAR ELECTRICAL CONTRACTING INC 610 SW 114TH AVE #1 INSURER C: MIAMI, FL 33174 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 DDLUBR NSR D I POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS-MADEE�OCCUR DAMAGE TO RENTED $ MED EXP (Anyone person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ NEWLAGGREGATE LIMIT APPLIES PER: POLICY = PROJECT= LOC PRODUCTS -COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS gU7pg NED COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per (Per person) BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) $ UMBRELLA UAB O OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB O CLAIMS-MADE DED I I RETENTION $ $ WORKERS COMPENSATION ANDWC EMPLOYERS' LIABILITY - PRWC549826 01/01/2014 01/01/2015 STATU- OTH- X e E.L. EACH ACCIDENT $ 100,000.00 ANY PROPRIETOWPARTNER/EXECUTIVE OFFICEIVMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 100,000.00 E.L. DISEASE - POLICY LIMIT $ 500,000.00 (Mandatory in NH) N/A IS yes, describe under DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) LICENSE # EC0000405 CERTIFICATE HOLDER CANCELLATION MIAMI SHORES VILLAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION BUILDING DEPARTMENT DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY 10050 NORTHEAST 2ND AVENUE PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR MIAMI SHORES VILLAGE, FL 33138 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) @1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Ear .0 + jr CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/Y" 1 TYPE OF INSURANCE 06/02/14 TRIS 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. INtPORTANT- If the certificate holder Is an ADDITIONAL INSURED, the poles) trust be endorsed. If SUBROGATION IS WAIVED, subject to the terms end conditions of the policy, cartain policies may require an endorsement. A statement on this cera icato does not confer rights to the certificate holder in leu of such endoreement(a). PRODUCER CONTACT Mary Urrego G=Mar Insurance PHDNE (305 2ST 4541 FAX (305) 267-4543 8200 W 33 Ave #7 MAL gmarinsumnce@gmail.com WSURE AFFORDING COVERAGE MAIC # Hialeah, FL 33018 INSURER A : Granada insurance company Phone 305 267-4541 Fax (305) 287-4543 INSURED INSURER B INSURERP: Prostar Electrical Contractor Inc., LIC # ECM0405 INSURER D 610 SW 114 AVENUE UNIT# 1 INSURER 6: MIAMI, FL 3$174 (786) 307-42D5 INSURER F: COVERAGES CERTIFICATE. NUMBER, 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; TERMOR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 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. INSADDLBUBR LTJ TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DF-UVER90IN ACCORDANCE WITH THE POLICY PROVISIONS, Miami Shores, Florida 33138 POLICY N MBER PDL YEFF M P CYEXP D LIMITS A 1 GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ❑ ❑ CLAIMS -MADE 1❑/ OCCUR ❑ j� N N 0185FL000182S7 43/29/2014 03/29/2015 EACH OCCURRENCE $ 1,000,000.00 DAMAGE TO RENTED 100,000.00 RE ISESy,�omrte cel $ MED EXP JMy one g2mcn $ 5,000.00 PERSONAL: 8 ADV INJUIW $ 1,000,000.00 GENERAL AGGREGATE $ 2,000,000.00 GEN'LAGGREGATE LIMIT APPLIES PER: 9 POUCY ❑ P O- E] Loc PRODUCTS - COMPIOP AGG $ 2,000,000,00 $ AUTOmDBILEi-IABiLrrY ® ANY AUTO ALL OWNED p-1 SCHEDULED ❑ AUTOS LJ AUTOS 1,1 HIRED ALiTOS E]ASO WINED ❑ MBIN OSINGLELIMIT BODILY INJURY (Per person) $ BODILY INJURY(Peraccidant $ P OPERTY" PAMAGE $ $ ❑ UMBRELLA LUW ❑ OCCUR ❑ EXSEss Lim ❑ CLAIMS•MADE EACH OCCURRENCE $ AGGREGATE $ DED ❑ _RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORJPARTNERIEXECUTIVEN OFFICERXEMBER EXCLUDED? (Manchdory in NH) El Byye_�s dsscrlbeunder DESGIRiPTiON OPERATIONS below A WC STATU- Q 4TH- TCRY LIM- — E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE4 $ E.L. DISEASE - POLICY LIMIT I $ DESCRIPTION OF OPERATIONS 1 LOCATONs i VEHicLEs (Mach ACORD 101, Addkional Remarks Schedule, it more space Is repaired) Electrical Contractor License # ECOOD0405 CERTIFICATE HOLDER CANCELLATION 0 1OM20ib ACQRD CbhPORATION. All rights reserved. ACORD 25 (2010105) OF The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE bESCRIBED POLICIES BE CANCELLED 13EFORE Miami Shores Village 10050 NorthEast 2nd Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DF-UVER90IN ACCORDANCE WITH THE POLICY PROVISIONS, Miami Shores, Florida 33138 AUTHORIZED REPRESENTATIVE - Mary. UrregD j 0 1OM20ib ACQRD CbhPORATION. All rights reserved. ACORD 25 (2010105) OF The ACORD name and logo are registered marks of ACORD City of Sweetwater 500 SW 10914 Ave Sweetwater FL 33174 Business Tax Deeartment (305)221-0411. Business Tax Receipt Effective Date: 10/1/2013 Expiration Date: 9/30/2014 PROSTART ELECTRICAL CONTRACTOR INC 610 SW 114 AVE I Sweetwater, FL 33174 ARMANDO LEON Phone Number: Administrative Office r] U Penalty Is Imposed for failure to keep this receipt displayed conspicuously 331 ? 4 VCf-3 t 40 -,0 aixwev soaves 02 1 ID $000-330 0003150'188 OCT 21 2013 MAILED FROM ZIP COOE 33174. License Description, Administrative Office License No, 104000057, Restrictions, PROSTART ELECTRICAL CONTRACTOR INC 640 SW 114 AVE I SWEETWATER, FL 33174 ii ii til fill, II)J1I 1111j;J11,1111 fill III