DS-15-742Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-231434 Permit Number: DS -4-15-742
Scheduled Inspection Date: May 15, 2015
Inspector: Rodriguez, Jorge
Owner: , BARRY UNIVERSITY
Job Address: 11300 NE 2 Avenue
Miami Shores, FL 33138-0000
Project: <NONE>
Contractor: P133 CONSTRUCTION CORP
sunamg Department comments
Permit Type: Driveways/Sidewalks/Slabs
Inspection Type: Final
Work Classification: New
Phone Number
Parcel Number
1121360000050
Phone: (305)389-0065
NEW SIDEWALKS AT BENINCASA AND O'LAUGHLIN Infractio Passed Comments
BUILDINGS I INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
May 14, 2015 For Inspections please call: (305)762-4949 Page 5 of 27
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
Phone: (305)795-2204
11300 NE 2 Avenue
Miami Shores, FL 33138-0000
Parcel Number
1121360000050
Block: Lot:
BARRY UNIVERSITY INC
Owner Information Address Phone Cell
BARRY UNIVERSITY INC 11300 NE 2 Avenue
MIAMI SHORES FL 33161-6628
11300 NE 2 Avenue
MIAMI SHORES FL 33161-6628
Contractor(s) Phone Cell Phone
PP3 CONSTRUCTION CORP (305)389-0065 (305)757-5129
In Review
Approved:: In Review
Denied:
of Work: NEW SIDEWALKS AT BENINCASA AND O Additional Info:
Retum : Classification: Commercial
ninq: 3
Fees Due
Amount
CCF
$7.20
DBPR Fee
$2.25
DCA Fee
$2.25
Education Surcharge
$2.40
Permit Fee
$150.00
Scanning Fee
$9.00
Technology Fee
$9.60
Total:
$182.70
Valuation: $ 12,000.00
Total Sq Feet: 1000
Pay Date Pay Type Amt Paid Amt Due
Invoice # DS -4-15-55020
04/27/2015 Credit Card
04/01/2015 Credit Card
$ 132.70 $ 50.00
$ 50.00 $ 0.00
Avauaole
Inspection Type:
Final
Foundation
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AF
certify that a foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction aFuthe e, Iabove named contractor to do the work stated.
April 27, 2015
Au razed Signature: er pplicant / Contractor / Agent Date
Bu"fling Department Copy
April 27, 2015 1
a1�31�a�5
BUILDING
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
OBUILDING ❑ ELECTRIC ❑ ROOFING
APR OtZffi
FBC 20 l O
Master Permit No. -� I
Sub Permit No.
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING [:]MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 11300 NE 2nd Avenue
City: Miami Shores County: Miami Dade Zip: 33161
Folio/Parcel#: Is the Building Historically Designated: Yes NO XX
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): Barry University, Inc. Phone#: 305-899-3797
Address: 11300 NE 2nd Avenue
City: Miami Shores State: Florida Zip: 33161
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: PP3 Construction, Corp. Phone#: 305-389-0065
Address: 750 NE 96th Street
City: Miami Shores State: Florida Zip: 33138
Qualifier Name: Gabriel Rodriguez Phone#: 305-389-0065
State Certification or Registration #: CGC1516509 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State Zip:
Value of Work for this Permit: $12,000 Square/Linear Footage of Work: 1000 SF
Type of Work: ❑ Addition ❑ Alteration New ❑ Repair/Replace
Description of Work: New sidewalks at Bennincasa and O'Laughlin Buildings
❑ Demolition
Specify color of color thru tile:
Submittal Fee $ n ° Permit Fee $ VA CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $
(Revisedo2/24/2014)
DBPR $
Notary
Double Fee $
Bond $
TOTAL FEE NOW DUE $ '2* l
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.
6 Signature —"..Signature
OWNERorAGENT CONTZCTOR
The foregoing instrument was acknowledged before me this
t31 5V nday of �/'P'x�1 20 LS , by
�u1•�U� Iws � w� hoismamannlly known to
meor who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Notary Public Stfa o0 Fb*M
Jeft J Yao
+A My Commission FF 188481
p,µ Expkes 11/1202018
The foregoing instrument was acknowledged before me this
day of _ _Atka, , 20 IS by
%�;V DAA& Z who is personally known to
as me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:_
Print:
Seal: Notary Pubic State d FWWa
Js" J Yao
+�My Cormnissim FF 188481
q Ei*m 11N2*018
P
APPROVED BY ` v Plans Examiner
Structural Review
(Revised02/24/2014)
as
W /l Zoning
Clerk
� Ro® CERTIFICATE OF LIABILITY INSURANCE
DATE(MWDD/YYYY)
03/23/2015
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 terns 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).
PRODUCERN
Merchant Insurance Solutions
12326 Isabella Drive
c Staid Merchant
NAME
PHONE (239) 823-4382 ----T—FAX No : (111)111-1111
Aool�: smerchant@merchantinsurancesolufions.com
INSURER(S) AFFORDING COVERAGE NAIC 0
000642270
INSURERA: James River Ins Co
Bonita Springs FL 34135
INSURED
INSURERS: Wesco IrIS CO
INSURER C : Florida Citrus Business Industries Fund
PP3 Contruction Corp
INSURER D:
750 NE 96th Street
INSURER E:
PRODUCTS-COMP/OPAGG $ 2,000,000
INSURER F:
Miami FL 33138
COVERAGES CERTIFICATE NUMRFR! REVISION NUMRFR-
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.
INS
TYPE OF INSURANCE
ADDLSUBR
D
POLICY NUMBER
POLICY EFF
MIDDIYYYY)
POLICY EXP
(MMIDDfYYYY11
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE XOCCUR
000642270
10/10/2014
10/10/2015
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED— PREMISES Ea occunym $ 100,000
MED EXP (Any one person) $ 5,000
PERSONAL &ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY 0 ECT LOC
OTHER:
GENERAL AGGREGATE $ 2,000,000
PRODUCTS-COMP/OPAGG $ 2,000,000
$
B
AUTOMOBILE
X
LIABILITY
ANY AUTO
ALL ED �/ AUTOSSCH
/�
NON -OWNED
HIREDAUTOS X AUTOS
WPP112766401
10/10/2014
10/10/2015
COMBINED SINGLE LIMIT $ 1,000,000
Es accident)
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERDAMAGE $
UMBRELLA LIAB
EXCESS LIAR
OCCUR
CLAIMS -MADE
EACH OCCURRENCE $
AGGREGATE $
DED I I RETENTION $
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPROMEMBER/EXCLUERIE ECUTIVE Y❑
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
10649201
03/14/2015
03/14/2016
X STATUTE -ToRH
I-LEACHACCIDENT $ 1,000,000
E.L. DISEASE - EA EMPLOYEd $ 1,000,000
E.L. DISEASE - POLICY LIMrr I $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached B more space is requhed)
General Contractor
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
The Village of Miami Shores ACCORDANCE WITH THE POLICY PROVISIONS.
10050 NE 2nd Avenue AUTHORIZED REPRESENTATIVE
Miami Shores FL 33138
@ 1588-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
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