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ELC-14-2564Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-223760 Scheduled Inspection Date: March 27, 2015 Inspector: Devaney, Michael Owner: , BARRY UNIVERSITY Job Address: 11300 NE 2 Avenue Library Miami Shores, FL 33138-0000 Project: BARRY UNIVERSITY Permit Number: ELC-11-14-2564 Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition/Alteration Phone Number Parcel Number 1121360010160-03 Contractor: LINDMAR ELECTRIC INC Phone: (305)756-1075 rsunamg uepanment comments OUTLETS & LIGHTING INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. March 27, 2015 For Inspections please call: (305)762-4949 Page 5 of 29 r. 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 NOV �� �i� "U, FBC 20 BUILDING Master Permit j No. -(L'c ^ �d� �/�"� PERMIT APPLICATION Sub Permit No.1C L— � -aS( ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: //30 d IV6f Aoe-, AY' L 1jW4Y gpo M 301 City: Miami Shores County: Miami Dade Zip: .5 -3 I6 / Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): %3��y%y U/✓, l✓AwSo -s,'/-. -���' Phone#: Address: /'r& C%C7 /Y C^ o�NG� /�UZ` City: h%i a A4e '/���� State: 1-f-6 Zip: _5�3 /'gr Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: Z�/A.'PZtljg C- Z_C-e Phone#:,306 -AZ Address: �Me/e AJ e? Jl , a City: �a A L State: Zip: , � 31 J e Qualifier Name: _ ,%�%r%� Phone#: State Certification or Registration #: Certificate of Competency #:0,00 0 %76 ��6� DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ Wow D (96� Square/Linear Footage of Work: 2's-0 Type of Work: ❑ Addition E Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: of 11A1 -9 �.A Specify color of color thru tile: .Y Submittal Fee $ � '®� Permit Fee $ Z jtvo 0'4�' CCF $ CO/CC $ Scanning Fee $ Technology Fee Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ ( '_� 8190 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. OWNER or AGENT The foregoing instrument ,nwas acknowledged before me this day of MOVW99X 20 by VASAN POR NMAL , who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: 4" V Sign: Print: - A e Notary Public StM of Florida F . J8iby J Yao M My Conanission FF 168481 E Q. Explru 11n2n018 as Signature CONTRACTOR The foregoing instrument was acknowledged before me this da of Novi"�&r .20 , by d�� 41�G{���t� t' i h cl , who is personally known to me or who has produced D`ivc^ CtAm as identification and who did tak CA gLINA MONTEAL€GRE NOTARY PUBLIC:�® NOTARY PUBLIC _STATE OF FLORIDA Comm# EE152305 `r® �® Expires 12/11/2015 Sign: 1 ' � Print: Seal: APPROVED BY ' Plans Examiner Zoning Structural Review (Revised02/24/2014) Clerk RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD ER0013500 "he ELECTRICAL CONTRACTOR Namea aelow HA5 mmujo i trctu Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 (INDIVIDUAL MUST MEET ALL LOCAL LICEN REQUIREMENTS PRIOR TO COhITRACT�NI LIND, ORLANDO EMMANUEI_y SING I N ANY AREA) LINDMAR ELECTRIC, INC 496 NE 89TH ST EL PORTAL FL�K�tt . ISSUED: 10/21/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1410210002916 0 --. [ :� int :. n-- ate■--�f:�#:�l:i�"[tMvA ■ a1�4u� .....-.�,.t .4-c6mh® LIABILITY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE DATE (AAImmorm EXPIRATION DATE THEREOF, THE MM INSURER WILL ENDEAVOR TO MAIL MIAMI SHORES VILLAGE INSURANCE 10/29/14 PRODUCER Annette Willis Insurance MIAMI SHORES, FL 33138 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 18401 N.W. 27 Ave ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Miami, FL 33056 ALTER THE COVERAGE AFFORDED BY THE POLICI BELOW, INSURERS AFFORDING COVERAGE NAIC # Phone (305) 625-2403 Fax (305) 625-6472 INSURED LINDMAR ELECTRIC INC C/O ORLANDO LIND INSURER A. GRANADA INSURANCE COMPANY INSURER B: GRANADA INSURNCE COMPANY 496 NE 89 ST EL PORTAL, FL 33138 INSURER C:INSURER D: INSURER E COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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 POLICES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSLTR SFIO TYPE OF INSURANCE POLICY NUMBER DATE � EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE 1,000,000 © COMMERCIAL GENERAL LIABILITY 0185FL00052491 09/09/14 09/09/15 PRREMSEs Ere100,000 a oc curenoe MED EXP (Any arts ) 5,000 0 E CLAIMS MADE © OCCUR A ❑ ❑ PERSONAL & ADV INJURY 1,000, 000 ❑ GENERAL AGGREGATE 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG 1,000,000 © POLICY ❑ PROJECT ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ ANY AUTO 0110FL00012396 09/06/14 09/06/15 (Ea accidet BODILY INJURY 10,000 (Per person) B ❑ ❑ ALL OWNED AUTOS © SCHEDULED AUTOS ❑ HIRED AUTOS El NON OWNED AUTOS GODLY INJURY (Per accident) 20,000 ❑ PROPERTY DAMAGE 10,000 (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ❑ ❑ ANY AUTO OTHER THAN EA ACC ❑ AUTO ONLY: AGG EXCESSlUMBRELLA LIABILITY EACH OCCURRENCE AGGREGATE F1ElOCCUR ❑ CLANS MADE ❑ DEDUCTIBLE ❑ RETENTION $ EWORKERS MPLOYERS, MPENSATION AND LIABITYER ❑ WC STATS ElOTH- EACH ACCIDENT ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? If Ves, describe under -EL E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS ELECTRICIAN VEH # 1) 99 FORD ECONOLINE VIN # 1FTPE2424XHB39812 CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001/BE) QF CoLL«�1;Iplvioli *][r_YIL$lcfiF1 ] SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE MM INSURER WILL ENDEAVOR TO MAIL MIAMI SHORES VILLAGE 30 DAYS WRNTIEN NOTICE TO THE CERTIFICATE HOLDER NAMED To 10050 NE 2ND AVENUE THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY MIAMI SHORES, FL 33138 OF ANY FOND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2001/BE) QF CoLL«�1;Iplvioli *][r_YIL$lcfiF1 ] Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if - 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company. Therefore, you may be personally liable for the worker compensation injuries of any person allowed to work under this permit Please check with your insurance carrier since most property insurance policies DO NOT cover this type of liability. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Print Name:. ► � Iii Contractor Print Name:�� Signature: _State of Florida) State of Florida ) County of Miami -Dade) County of Miami -Dade ) Sworn to and subscribed before me this Sworn to and subscribed before me this 131 day of 6(_ , 20 day of — 9 , 20. J Yeo 1x4W4 Eo cad ' (SEL) Notary Public ®tat@ Bf A6fidj �n10 ni.GIVE �v, Tvpe of Identificati ; cid �w�..W.. MN /"49.