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CC-14-662BUILDING PERMIT APPLICATION Miami Shores Village 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 ®BUILDING ❑ ELECTRIC ❑ ROOFING FBC 20 Master Permit No. cC_+ Iii d GG z_ Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: _ _�, 00 "L Zile ot\D e C= Agit EP, L4(.\ L L City: Miami Shores County: Miami Dade Zip: 331(o N Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): f f �j 00� v�� i � Phone#: X05 -9901- -33 Address: W,- � 2n CA dAUPi.0Q 1 City: 1M %cAm hcfe-c . State: V lust C\u Zip: 3�Ls i u t Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: � � �3 �I'ycAruckk' un Phone#: 2"LIE-ii I - 7- Address: Sbo I �Z_ S�rce`i City: mlwy\k S`�rr_,s State: P\ori ack Zip: .?)?S\mss Qualifier Name: ,- e -f °� STCL_ S. ; J` Phone#: ®15�- State Certification or Registration*: Certificate of Competency #: DESIGNER: Architect/Engineer: 1Oa RocryK`1 i K f7h�C , LLL WW Phone#: + q (o � 9_3 Address: VX���� -D a,�� �%� City: .Ljo&fAde.State:�Zip: Value of Work for this Permit: $3M CM - Square/Linear Footage of Work: Type of Work: ❑ Addition EZ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: fre.(- �\Mk -\_2es�roofy) R�l")UOA;Uls Specify coir of °coidr thru ripe: 4. Submittal Fee $ 4Permit Fee $.` CCF $ !° CO/CC $ OD Scanning Fee $ Radon Fee $ L� DBPR $ ��� ° Q3 Notary $ Technology Fee $ Training/Education Fee $ GCS • UD Double Fee $ Structural Reviews (Revised02/24/2014) Bond $ TOTAL FEE NOW DUE $ Iq64 E3 - 0" 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 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 charged. Signature qLI�P4' AEMM%'<FW,-5-AI/ Signat,,,ice\©�l�►ii= __`y` OWNER or AGENT. -- - r • e Thef9rhegoing instrument was acknowledged before me this 14day of 20 V4 by SkSAN 49MAL ,who -1s pnrcnnally k0own to me or who has produced identification and who did take an oath. NOTARY PUBLIC: as The foregoing instrument was acknowledged before me this day of , 20 , by . *'e (J ;. , who is oersonally known to me or who has produced li) /Ar as If identification and who did take an oath. NOTARY PUBLIC: IKTVSign: Sign:_ Print: MA Print: Seal: i e 1 APPROVED BY (Revised02/24/2014) Seal: MY COMMISSION 0 EE36829 EXPIRES: Nov®ba I2, 2014 y FLNaWyDb mtAsMC& r�Plans Examiner Structural Review MILDRED Y. GOMEZ Notary Public - State of Florida My Comm. Expires pug 24.2017 Commission # FF 40660 Zoning Clerk Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CHANGE OF CONTRACTOR 1 ARCHITECT Permit N. CC-4s1i -(A,2L Owner's Name (Fee Simple Title Holder):_&A `i Phone #: aa�— P)9 9 3052 Owner's Address: U30 30 E City: M i cI r State : P to rt tick Zip Code: 3 i to Job Address (Of where work is being done): 1 U 3 UQ k -3t 2 A 'nue City: Miami Shores State:—Florida Zip Code: Contractor's Company Name: Address: 6'60 'N� E_ hone #: City: t/i ►moi % Shore-) State: :1 of i Zip Code: V195 Qualifier's Name: . -3ef--V Lic. Number: CCG 011 Q�5 5 Architect/ Engineer of Record Name:. �' m�° _,5K►�Zom .tt>� Phone #: c1S+ `i 6I.. b�C* Address: _i_6 �1�e� �-fed C . f3u�x.00 City: Tf�f+ 1_ ude-rdClle State: T-Wfl 8c� Zip Code: �-_13 Describe Work: G%ar fl e_f' Vt ea` 1 I hereby certify that the work has been abandoned and/or the contractorlarchitect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless for all legal in of em nt. Signature Signature owner or Agent on r or ��bre The foregoing instrument was aknowledged before me The foregoing in ment was � me y this 9�_ day of 549 ,201y,by S414N &S6v*v this QAhday ofire_ 200 \by -L64 Who is personally known to me or who has produced who is personally known to me,pr who has produced as indentification. as indentification. Notary P /� Notary Public: Sign: Sign: Se � Y J. A® rtycommissioN#EB36829 ipyi MIL ED Y. GOMEZ Seal: ,,`o�,�� "`' - A :° = Notary Public - State of Florida ' 24, 2017 t"gD@ CUs: Nov=bgr t2, 2014 ,� Q My Comm. Expires Aug ��°•;rF t,}N�pRy n.vnC4L `• �-�'- Commission # FF 40660 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tet: (305) 795.2204 Fax: (305) 756 .8972 CONTRACTORS' REGISTRATION ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED. IF CONTRACTOR IS A FLOItII.TA STATIC CI RTII, i:CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT B. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. C. COPY OF LIABILITY INSURACE* D. COPY OF WORKERS COMPENSATION INSURANCE* `YOUR-INSURA14CE COMPANY MUST ISSUE A CERTIFICATE AS f'OL Certificate HaI+dert: MIAMI MORES VILLAGE BLDG DEPT 10050 NE 2NQ SAVE MIA -M SHOT S, FL 33138 COMcMe must SWIfy ttie'descrlotton d*i � tr tar lir erre naiaril r. BUSINESS NAME: 7o�►S�jD �® BUSINESS ADDRESS: S50 N T5 �� 11719CITY4/1a 1 ""® 541-c5 STATE__6�_ ZIP CODE 9 BUSINESS PHONE: FAX NUMBER (!of) CELL PHONE ( } 0-7 71 QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: ®// ®S37 STATE OF FLORIDA ULSTIO CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 STOBS, JAMES R II STOBS BROTHERS CONST CO 580 NE 92ND ST MIAMI SHORES FL 33138-3173 Congratulationsl With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from 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 better. For information about our services, please log onto www.myfloiidalicense.com. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and learn 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 licenses DETACH HERE RICK SCOTT, GOVERNOR (850) 487-1395 i STATE OF FLORIDA DEPARTMENT OF BUSINESS AND 2� le PROFESSIONAL REGULATION CGCO11055 ISSUED; 05/19/2014 CERTIFIED GENERAL CONTRACTOR STOBS, JAMES R II STOBS BROTHERS CONST:CO IS CERTIFIED under the provisions of Ch.489 FS. ExplraUan date : AUG 31, 2016 L1406190000947 KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD CGCO11055 The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 STOBS, JAMES R II STOBS BROTHERS CONST CO 580 NE 92ND ST MIAMI SHORES FL 33138-3173 ISSUED: 05!19/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1405190000947 STOBBRO-02 VERONICA .a►k �® CERTIFICATE OF LIABILITY INSURANCEF61512 DATD/YYY1) 6!512014 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 Acrisure, LLC d/b/a InSource 9500 South Dadeland Boulevard 4th Floor Miami, FL 33156-2867 CONTACT ac°NN , (305) 670-6111 F� Nol: (305) 670-9699 E-MAIL E-MAILs: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: National Fire Ins.Co. 20478 04/01/2015 INSURED INSURER B:Continental Casualty Company 20443 INSURER C: Transportation Insurance Co. 20494 Stobs Bros. Construction Co. INSURER D: Valley Forge Insurance Co. 20508 580 N.E. 92 Street Miami Shores, FL 33138 INSURER E: INSURER F: B GOVERAGES CERTIFICATE NUMBER! RFVISInN Ni IMRFR• 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 ADDLISUBR INSO WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR 4013762175 04/01/2014 04/01/2015 EACH OCCURRENCE $ 1,000,000 L 100 000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ® PRO- JECT El LOC POTHER: GENERALAGGREGATE $ 2,000,000 PRODUCTS -COMP/OPAGG $ 1,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO ALL AUTOSN� AUTOS NON -OX HIRED AUTO X AUT SEED 4015527434 04/01/2014 04/01/2015 COMB! ED SINGLE LIMIT Ea 4CLldent $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ERTY PRer acciderrtDAMAGE $ cEXCESSLIAB X UMBRELLA LIAB X OCCUR CLAIMS -MADE 4015527479 04/01/2014 04/01/2015 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED X I RETENTION $ 10,000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNEVEXECUTIVE YIN OFFICER/MEMBEREXCLUDED? (Mandatory In NH) Ues describe under RRIPTION OF OPERATIONS below NIA 1073762447 04/01/2014 04/01/2015 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 EL DISEASE -EA EMPLOYEE $ 1,000,00 EL. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) General Contractor - License No. CGC011055 CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014101) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Dept THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE ACORD 25 (2014101) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 000527 Local Business Tax Receipt Miami -Dade County, State of Florida —THIS IS OTA BILL— DO NOT PAY 265546 BUSINESS NAME/LOCATION STOBS BROS CONSTRUCTION CO 580 NE 92 ST MIAMI SHORES FL 33138 RECEIPT NO. EXPIRES RENEWAL SEPTEMBER 30, 2014 266646 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENTRECEIVED STOBS BROS CONSTRUCTION CO 196 GENERAL BUILDING CONTRACTOR BY TAX COLLECTOR Worker(s) 25 CGC011055 $90.00 07/09/2013 TXHS1-13-017323 This Local Business Tax Receipt only confirms payment of the Local Business Tax. Ilia Receipt is not a license, permit, ora cartiffcalion of the holders qualifications, to do business. Holder must Comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0. above must be displayed on all commercial vehicles — Miami—Dade Code Sec Da -276. For more information, visit www mtamidede goy/taxcollector Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-227767 Permit Number: CC -4-14-662 Scheduled Inspection Date: February 06, 2015 Permit Type: Commercial Construction Inspector: Rodriguez, Jorge Inspection Type: Final Building Owner: , BARRY UNIVERSITY Work Classification: Alteration Job Address: 11300 NE 2 Avenue Garner Building Miami Shores, FL 33138-0000 Phone Number Parcel Number 1121360010160-22 Project: BARRY UNIVERSITY Contractor: STOBS BROTHERS CONSTRUCTION CO Phone: 305-751-1692 comments RENOVATION OF 1ST AND 2ND FLOOR MENS AND .----- ­""" WOMENS RESTROOM GARNER HALL INSPECTOR COMMENTS False February 05, 2015 For Inspections please call: (305)762-4949 Page 29 of 32 Inspector Comments Passed Failed Correction Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. February 05, 2015 For Inspections please call: (305)762-4949 Page 29 of 32