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CC-14-663 (2)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 PERMIT APPLICATION BUILDING ❑ ELECTRIC ❑ ROOFING AUG f2\5 2014 Master Permit No. CC- `ii -14 - G(62� Sub Permit No. ❑ REVISION ❑ EXTENSION ❑ RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 0200 NiNE 2nd AA U C I Ay o I'E City: Miami Shores County: Miami Dade Zip: _5_3 1 (r, I Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder)_g )0 N'tr"4 On I Q -e_rs i �� Phone#: Address: IDC)® 2ncj AlLIG7 i 6h City: tafyl & skolfas State: P lur a �a Zip: � i co II Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: �S� � p `r ' (or)'S+rL;(+10 '� , Phone#: � 5 1 ®I -1 Address: Vie() U5 92nd t)�r�e4 City: X16 ary'Y '�!�Cre State: V' toy -i, on Zip: I Qualifier Name: ':Y. Rolbe_r+ F m Phone#: State Certification or Registration #: C1q C_C %tC1155 Certificate of Competency #: DESIGNER: Architect/Engineer: _S-jncA1 oys K d g0 rncw1 B \- G c�� e, Phone#: ct� _q o I_ (,bc�o Address: \bo (O � �6i . :�)Uj}d 600 City:Fj.1._aUc)KCj0I&,tate:_ F-1- zip: Value of Work for this Permit: $ 2co cxzk) - 00 Square/Linear Footage of Work: Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work:yoi c 2_nd Ftoo�- — Tn+c-_r I ar Specify color� 'ok thid'iff v Submittal Fee $ Permit Fee $ Scanning Fee $ Technology Fee Structural Reviews $ (Revised02/24/2014) Radon Fee $ Training/Education Fee $ CCF $ CO/CC $ DBPR $ Notary Double Fee $ Bond $ TOTAL FEE NOW DUE $ 5 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. A I q Signature &. koaj OWNER or AGENT The foregoing instrument was acknowledged before me this --I k• day of 0 - , , 20 J by slcm &5M (-, , w ersonally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Seal: 10/111TILA MR.3 :4F:.4 MY COMMIsstON N WOW FARES: Noeanber 1Z 2014 Y E1NdmyDtSMM Am,Q as The foregoing instrument was acknowledged before me this I � � day of zune- , 20 114 j . by . aCA SAC6 rff , who is personally known to mor who has producedel as identification and who did take an oath. NOTARY PUBLIC: Sign: C q Print I Seal: q APPROVED BY Plans Examiner Structural Review (Revised02/24/2014) MILOREO Y. GOMEZ Notary PuNc - State of Florida My Comm. Expires Aug 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 I ARCHITECT Permit N. CC -4 -14- C®(o--1 Owner's Name (Fee Simple Title Holder): Frat r y Ijnwcf-tj:`j Phone #: &, —Viq '--�G'S2 Owner's Address: i 1300 1,�F— 2r�d A-VU)00 City: _Mickm Skxre-a State : Zip Code: -3`> 1 1 Job Address (Of where work is being done): r 13 0 Q 11�a ?—f)6 AVVILY— City: Miami Shores State:—Florida Zip Code: '--VA I k i Contractor's Company Name: Address: SbO ,1Z e#: Ski -1661 City: `V'1%CAm't State: FICC, 6 C Zip Code: '-31Z9 Qualifier's Name : ,T 6efk , It Lic. Number: CC C- 011 bSS Architect/ Engineer of Record Name: 0(0irjS'V�t &ftA-1K y 'hone #: 954-- `16t- �9 � Address: V00 E1al�of oQg— ., 5ol� S®o City: Foo Wu&cJcA t State: Zip Code: I Describe Work: Lekyo-1 e— ao e 6a — --In+ or mnap nnrG em e I hereby certify that the work has been abandoned and/or the contractor/architect is unable or unwilling to complete the contract. I hold the Building Official and the Miami Shores harmless for all legal involy nt. Signature I & Signature L I\' - ls�.— owner or Agent tractor or Arch' The foregoing instrument was aknowledged before me The foregoing instrument was aknowledged before me G this � � day of ,201�,by 91450 ft"kL this Vh day of Une , 20)gby I 4 I JT- VI(tto is nersmQU knoW tom or who has produced Notary Sign: _' as indentification. who is pet_s_onally known to meior who has produced X/,4 as indentification. Notary Public: L Seal: �� P;;s' MILDRED OGYOMMEZ V4Y i,ol2,Zpg4 '2 '.°�= Notary Public - State of Florida My Comm. Expires Aug 24, 2017 Commission # FF 40660 STATE .- DEPATILITEVTBUS CONSTRUCTION INDUSTRY LICENSING BOARD 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 STOBS, JAMES R Il 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.myfioridalicanSG.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 licensel DETACH HERE (850) 487-1395 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CGCO11055 ISSUED:_ 05/19/2014 CERTIFIED GENERAL CONTRACTOR STOBS, JAMES R Ils. STOBS BROTHERS.CONST_GO`, IS CERTIFIED, under the provisions of Ch.489 FS. Expiration date : AUG 31, 2016 L140619MOO947 RICK SCOTT, GOVERNOR KEN LAWSON, SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD ^;Ig,b CGC011055 The GENERAL CONTRACTORw: Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 L 13 STOBS, JAMES R II STOBS BROTHERS CONST CO 580 NE 92ND ST MIAMI SHORES FL 33138-3173 r, r ISSUED: 05/19/2014 DISPLAY AS REQUIRED BY LAW SEQ # L1406190000947 000527 LocalBusiness Tax Receipt Miami -Cade; Cauntyr State of Florida THIS IS NOT A BILL - DO NOT PAY I RT 265546 BUSINESS NAME/LOCATION STOBS BROS CONSTRUCTION CO 580 NE 92 ST MIAMI SHORES FL 33138 RECEIPT NO EXPIRES RENEWAL SEPTEMBER 30, 2014 265546 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 8 & 10 OWNER SEC. TYPE OF BUSINESS PAYMENT RECEIVED ST09S BROS CONSTRUCTION CO 196 GENERAL BUILDING CONTRACTOR BY TAX COLLECTOR Worker(s) 25 CGC011055 $90.00` 07/09/2013 TXHS 1--13-017323 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, are certhication of the holders qualifications, to do business. Holder most 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 See 80-276. For more information, visit vaww miamidade noyltexcollector STOBBRO-02 VERONICA CERTIFICATE F LIABILITY INSURANCE DATE6 /YYY1t7 6/55/20/20 14 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(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 CONTACT PHONE FAX o Ext : (305 ) 670-6111 ac No): (305) 670-9699 Alc No' 4th Floor Miami, FL 33156-2867 E-MAILs: INSURERS) AFFORDING COVERAGE MAIC # X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE N OCCUR INSURER A: National Fire Ins.Co. 20478 INSURED wsuRmB:Continental Casualty Company 20443 Stobs Bros. Construction Co. INSURER C: Transportation Insurance Co. 20494 INSURER D: Valley Forge Insurance Co. 20508 580 N.E. 92 Street Miami Shores, FL 33138 INSURER E : INSURER F GEMLAGGREGATE LIMIT APPLIES PER: POLICY N PR- EILOC OTHER OTHER VVVCIRAU=0 CFRTIFICATF NI IMRFR• oL9A01e%K1 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. INSR7R TYPE OF INSURANCE ADL B POLICY NUMBER POLICY EFF MM/DD POU EXP MMIDD UMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE N OCCUR 4013762175 04/01/2014 04/01/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE M RENTED-- PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEMLAGGREGATE LIMIT APPLIES PER: POLICY N PR- EILOC OTHER OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS -COMPIOPAGG $ 1,000,000 $ B AUTOMOBILE X LIABILITY ANYAuTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 4016527434 04/01/2014 04/01/2015 CO BINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ RPE GE Peracddent $ $ C X [] UMBRELLA L'M EXCESS LIAR X OCCUR CLNMS-MADE 4016527479 04/01/2014 04/01/2015 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED I X I RETENTION $ 10,000 $ D WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? ® (Mandatory in NH) Dyyes describe under DESG�RIPTION OF OPERATIONS below NIA 1073762447 04/01/2014 04/01/2015 PER OTH- X STAME ER E.L. EACH ACCIDENT $ 1,000,000 EL DISEASE -EA EMPLOY $ 1,000,000 EL. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached K more space is required) General Contractor - License No. CGCO11055 Miami Shores Village Building Dept 10050 NE 2nd Avenue Miami Shores, FL 33138 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD i 4v. BinDING Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Com` mc. PERMIT APPLICATION Permit No. Master Permit No. l ` (v 3 FBC 20 L,� Permit Type: BUILDING ROOFING Owner's Name (Fee Simple Titleholder) BgM Universi Le, # 305.899.3995 Owner's Address 11300 NE 2nd Ave City Miami Shores State FL Zip 33138 Tenant/Lessee Name Phone # Email Job Address (where the work is being done) Bary University- LaVoie -2nd Floor East Renovation City Miami Shores Village County Miami -Dade . Zip FOLIO / PARCEL # 11-2136-000-0050 Is Building Historically Designated YES NO X Flood Zone Contractor's Company Name PP3 Construction Contractor's Address 750 N E 96th Street city Miami Shores State FL Qualifier Name Gabe Rodriguez State Certificate or Registration No. CGC1516905 Contact Phone 305.389.0065 Phone # 305.757.5129 _zip 33138 Phone # Certificate of Competency No. E-mail gabe@PP3construction.com Architect/Engineer's Name (if applicable) Synalovski, Roman ik, Saye phone # 954.961.6806 Value of Work For this Permit $. 200,000.00 Type of Work: []Addition NAlteration Describe Work: '0/(f Square / Linear Footage Of Work: _ ❑New ❑ Repair/Replace V14- b ❑ Demolition Submittal Fee $ I Permit Fee $ CCF $ CO/CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $_ See Reverse side -+ 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 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—,&Z < Signature Owner or Agent /&ntra or The foregoing instrument was acknowledged before me this The f regoing instrument was acknowledged before me this days 0 , by Cu -,;C -h QP� day of ®� , 201, by ho is personall o me or who has produced who is personally known to me or who has produced r -D As identification and who did take an oath. NOTARY PUBLIC: Sign: U A I Print: My Commission W APPROVED BY (Revised 07/10/07)(Revised 06/10/2009) LORI L. CAJAS Notary Public - State of Florida My Comm. Expires May 30, 2014 Commission # DD 979550 Bonded Thiough National Notary Assn. 4 Plans Examiner Engineer as identification and who did take an oath. NOTARY UBLIC: \\\\,\0\II I I u u It/ Sign:Cn Print: My Commission Expires, `'�' •° Ge ". �� Zoning Clerk checked Florida Department of sMAN= amy Environmental Protection - 40ant4ftle DIMM AWQmkyManag=aoAl%,Won Dhi mWon of Air Resource htmagement Nn MW. I st Cour4 SM Fkw NOTICE OF DEMOLITION OR ASBESTOS RENOVATION new, Fo 33'3 ' TYPE OF NOTICE (CHECK ONE ONLY).- OORIGINAL TYPE OF PROJECT (CHECK ONE ONLY).- EIDEMOLITION IF DEMOLITION, IS ITAN ORDERED DEMOLITION? IF RENOVATION: IS IT AN EMERGENCY RENOVATION OPERATION? IS IT A PLANNED RENOVATION OPERATION? 1. Facility Name Address fl300PIE 2ND AVENUE City WWWORES _ Site LAVOIE BLS A OFFM2NOFMOR Building Size�'..(Square Feet) Prior Use. ®Sc WWollege/University 11 Residen Present Use: OSchool/College/University 13 Residence if. Faujity OUW BARRY COLLEGE Address 113GONE2ND AVENUF- 13 YES Q No Me 0 YES ONO ,Procftss I - FL Zip 33181 unty DADE —Consultant Inspecting Sfte�_ DP4�="Rclmm of Floors 2 Building Age in Years 35+ ce Osmajj Business Other 13 Small Business Other Phone( City MKW SHORES State FL 23 _33M III. Ca*actoes (W 2754HM4 Address 15757 PWS BLVD #253 Phone City±E33M Is the contractor exempt from licensure under section 469.002(4), F.S.? 13 YES ONO W. Scheduled Dates: (Notice must he postmarked 10 working days before the project start date) Asbestos Removal (nwWddfyy) St"_t2s-=4 Finish: 8-1-=4 Demo/Renovation (rnnVdd/yy) Start—Finish". V Descriptim of planned demolition or renovation work to be performed and methods to be employed, Including demolition or renovation technkluies to be used and description of affected facility components. Procedures to be used (Check'All ThatAoniv): "Ujkl�' jig .11. VL Precedttties for Unexpecied RACM; STOP WORK NOTIFY VII. Asbestos wasteitaraporta.. Name Sm Phone U_ Address 718 LANTANA RD State Z'ip VIII. Waste Disposal Site: Name CENTRAL SANITARY LANDFILL Address 3000&W.48AVE City . _LQ ANO �PaEACH State aZj; "UMT'y MANAGEMENT DIVISION IX RACM or ACW Procedure, including analytical methods, employed to detect the presence of kA CM aMitA"raW QabftW0M@.AQ& Amount of RACM or ACM* Submftd In Cbmpliance WWI square feet surfacing material j *PI I b f linear feet pipe square feet cernentififlous square feet r 11 !�­14-19 cubic feet of RACM Off facility components square feet -_--lDate *1denti7y and describe surfacing material and other materials as applicable: FLOOR T&ES& MASTIC Z= SQ FT & WINDOW CAULK ICOLDIFT I cer* that the above information is conea and that an individual trained In the provisions of this regulation (40 CFR Part 61, Subpart M) will he on- site during the demolition or renovation and evidence that the required training has been accomplished by this person will he available for inspection during normal business hours. NQBMMMILLM (F%nVjAne of I 111 5— 275-2 14-2014 964-534 (Si grtah=mof (0wr"1OFwraWr) (Date) rrrmta'.f .1— 01 Postmark0ate Received ID DwrawtmoN: vvhjtE�_DERM yellow -Applicant pjnk_Reem Gold -Reserve VL Precedttties for Unexpecied RACM; STOP WORK NOTIFY VII. Asbestos wasteitaraporta.. Name Sm Phone U_ Address 718 LANTANA RD State Z'ip VIII. Waste Disposal Site: Name CENTRAL SANITARY LANDFILL Address 3000&W.48AVE City . _LQ ANO �PaEACH State aZj; "UMT'y MANAGEMENT DIVISION IX RACM or ACW Procedure, including analytical methods, employed to detect the presence of kA CM aMitA"raW QabftW0M@.AQ& Amount of RACM or ACM* Submftd In Cbmpliance WWI square feet surfacing material j *PI I b f linear feet pipe square feet cernentififlous square feet r 11 !�­14-19 cubic feet of RACM Off facility components square feet -_--lDate *1denti7y and describe surfacing material and other materials as applicable: FLOOR T&ES& MASTIC Z= SQ FT & WINDOW CAULK ICOLDIFT I cer* that the above information is conea and that an individual trained In the provisions of this regulation (40 CFR Part 61, Subpart M) will he on- site during the demolition or renovation and evidence that the required training has been accomplished by this person will he available for inspection during normal business hours. NQBMMMILLM (F%nVjAne of I 111 5— 275-2 14-2014 964-534 (Si grtah=mof (0wr"1OFwraWr) (Date) rrrmta'.f .1— 01 Postmark0ate Received ID DwrawtmoN: vvhjtE�_DERM yellow -Applicant pjnk_Reem Gold -Reserve SYNA LOVSK I ROMAN I KSAYE AOM, h,,e • PI - Wag •itiPtlOP UCSigu _ June 20, 2014 Miami Shores Village c/o Building Department 10050 N.E. 2nd Avenue Miami Shores, Florida 33138 RE: Barry University Lavoie Hall 2"d Floor East Interior Improvements 11300 NE Second Avenue Permit No. M2014007993 To Whom It May Concern: As the Architect of Record, we offer the following as clarification as it relates to the Fire Department Comments issued to date for the Lavoie Hall 2nd Floor East Interior Improvements (Permit No. M2014007993). Fire Critique dated 06/02/14 - Diazo Q1. We assumed the building is not provided with fire alarm and fire sprinkler system. If so, indicate on plans, otherwise provide conceptual drawings indicating existing, relocated and new devices. R1. There is no existing Fire Alarm or Fire Sprinkler System, please see revised not eon revised Details, SheetA 201. Q2. Indicate the rehab. class in accordance with FFPC 101, Chapter 43. It looks like a reconstruction, please clarify on plans. R2. The modifications area Level -9 alteration as per FRC 2010 and renovation as per NFPA 101, Chapter 43 1(-9), please see revised not on revised Detail s, SheetA 201. Q3. Correct occupant load calculation provided on page A-201. 1/15 SQ. FT. for conference rooms 120 & 106 and receptions 117 & 121. R3. Occupant load has been updated to include 1/15 SQ. FT. for conference rooms and reception, please see revised not on revised Details, SheetA-201. Two egress doors have been revised to swing out towards the path of egress. Q4. Correct common path of travel from existing office #4. Max. allowed = 75, FFPC 101, Table 4.7.6.. R4. Common path of travel from existing office #4 is 31 ' 7"and the worst case from Office #10 is 32' 6"has been shown on revised Detail2, SheetA-201 and does not exceed 75' We believe that you are reading the Max. Travel Distance which is max. 200' in lieu of the Common Path of Travel dimensions SYNALOVSKI ROMANIKSAYE Architechere • Planning - Interior Design 1800 Eller Drive, Suite 500 • Fort Lauderdale, FL 33316 T 954.961.6806 F 954.961.6807 • www.synalovski.com SYNA LOVSK I ROMAN I KSAYE Atthlle -' • Plmming • btteri , Dl ign Q5. Storage room 118 to be provided with 1 hr. fire rated enclosure FFPC 101:38.3.2.1 with • 45 min. door 118 provided with self closing device. Provide UL wall assembly details and provide permanent mark above ceiling, both sides of fire rated partitions to comply with FFPC 101:8.3.2.4. R5. Room name has been corrected to Supplies, only office supply materials will be stored in this room. No fire rating required. Q6. Provide 1 hr. separation for new corridors 122 & 123 as per FFPC 101:38.3.6 and existing breezeway, FFPC 101:7.5.3.3 unless to comply with FFPC 101:38.3.6(2). R6. Building is a single tenant building, FFPC 101:38.3.6(2) applies Note added. Q7. If building will be in use during construction, explain how to comply with FFPC 101:3.6.11.1, FFPC 1:16.4.2.1. and NFPA 241. Provide details for required barrier if needed, otherwise indicate on plans R7. Only the four administration offices and one administration position will be used during the course of construction, so the one means of egress at the North end will be adequate to serve them and they will not have access to the area South on the interior side of the project. Nonetheless we have added the "construction barrier shall be maintained as per NFPA 4.6.11 "note to revised Detail 2, 5heetA-201. Q8. Correct redmarks on office copy set, page A-201. R8. Corrects have been made to plans and new sheets issued. Revision 2, dated 06.12.14. Missing door frames added. Q9. Mechanically reproduce corrections (i.e. new sheets) and return all previously reviewed void sheets for comparison. R9. Done and legend added for areas identifying areas where no scope of worn is Please feel free to contact our office should you have any further questions. Merrill Romanik, AIA Project Architect SYNALOVSKI ROM ANIKSAYE Architecture • Planking - Interior Design 1800 Eller Drive, Suite 500 • Fort Lauderdale, FL 33316 T 954.961.6806 • F 954.961.6807 • www.synalovski.com April 17, 2014 Miami Shores Village c/o Building Department 10050 N.E. 2nd Avenue Miami Shores, Florida 33138 RE: Bary University -Lavoie Hall -East Second Floor Renovation 11300 NE Second Avenue Permit No. CC 14-663 To Whom It May Concern: As the Architect of Record, we offer the following as clarification as it relates to the Building Department Comments issued to date for the Lavoie Hall East Second Floor Renovation (CC 14-663) Building Critique dated 04/07/14 - Ismael Naranjo Q1. Fire and DERM approval is required. R1. Comment has been noted and will be provided. Q2. Specify the connections of the metal track both for the top and bottom tracks. R2. See drawing 11 on sheet A-201. Q3. Window replacement notes on sheet A-201, note 8 makes reference to detail 9/A201, however detail 9/A201 is for cabinets. R3. Note 8 has been updated to reflect the proper detail. Q4. Provide interior finish schedule as required under chapter 8 of FBC 2010. R4. See drawing 4 on sheet A-301. Note has been added to represent specifications. Plumbing dated 04/01/14 - Osvaldo Diaz Q1. Provide plumbing pians for sink, water heater, piping, etc. R1. No sink or water heater part of scope. Mechanical Critique dated 04/07/14 - Jan Pierre Perez Q1. Missing permit application. R1. General contractor to handle. • SYNALOVSKIROMANTKSAYE AnittMdwe • P1mvdtkV • Interor L)esign 1800 Met hive, Su* 540 • fort Lauderdale, FL 33316 T 054.961.6806 • 11954.9616807 • w•ww._rytrelovski.com SYNA WVS K I &OMAN I K SAYE Electrical Review dated 04/07/14 Q1. Need permit application. R1. General Contractor to handle. Please feel free to contact our office should you have any further questions. Merrill Romanik, AIA Project Architect SYNALOVS TZi Ro MANT KSAYE An -hap. hae • Plmu • Ink or amp, 1800 Eller Drive, Suite 500 • Fort Lauderdale, Ft 33316 7954961.6906 • F 954.961.680' • WWW..SyWkWSW.com ' Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 April 7, 2014 _ Permit No: CC14-663 Mov 1366P e Review 1. Fire and DERM approval is required. 2. Specify the connections of the metal track both for the top and the bottom tracks. 3. Window replacement notes on sheet A-201, note 8 makes reference to detail 9/A201, however detail 9/A201 is for cabinets. 4. Provide interior finish schedule as required under chapter 8 of FBC 2010. Ismael Naranjo Building Official Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re -submittal drawings. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 April 1, 2014 Permit No: CC14-663 PLUMBING — OSVALDO DIAZ 1. PROVIDE PLUMBING PLANS FOR SINK, WATER HEATER, PIPING ETC... Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re -submittal drawings. Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 April 7, 2014 Permit No: CC14-663 Mechanical Critique — Jan Pierre Perez 1. Missing permit application. Plan € ;j not ..io complete, pall items above f ¢s corrected, dwe willdoa compleU plan If any sheets are voided, remove them from the plans and replace with n re-submittalew revised sheets and Include one set of voided sheets in the � Y . YY Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 April 7, 2014 Permit No: CC14-663 ELECTRICAL REVIEWER COMMENTS 1. Need permit application. Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re -submittal drawings. k tr k fM2Qq007c1q?? NOTE: ALL SHEETS MUST BE REVIEWED MIAMI-DADE COUNTY BUILDING DEPARTMENT Herbert S. Saffir Permitting and Inspection Center 11805 SW 26th Street (Coral Way), - Miami, Florida 33175-2474 - (786) 315-2100 APPLICATION FOR MUNICIPAL PERMIT APPLICANTS THAT REQUIRE PLAN REVIEW FROM MIAMI-DADE FIRE RESCUE AND/OR DEPARTMENT OF ENVIRONMENTAL RESOURCES MANAGEMENT PROVIDE MUNICIPAL PROCESS NUMBER HERE CC -14-663 Job Address 11300 NE 2nd Avenue, Miami Shores, FL 33138 Contractor No. CGC1516905 FOI10 11-2136-000-0050 c c Last four (4) digits of Qualifier No. _ .o Contractor Name PP3 Construction, Corp. - Lot Block Qualifier Name Gabriel Rodriguez x 0 0- Subdivision PBpg z LL 03 Address 750 NE 96th Street Metes and bounds City Miami Shores State FLL Zip 33138 [ ] New Construction on [ ] Demolish Current use of property University w Vacant Land [ ] Shell Only • [x] Alteration Interior [ ] Addition Attached 01 [ ]Alteration Exterior [ ] Addition Detached Description of Work LaVoie B1dg.Interior Renovations W o [ ] Relocation of Structure [ ] Re -Roof [ ] Enclosure [ ]Foundation Only z,000 Sq. Ft. Units Floors [ ] Repair [ j Repair Due to Fire Value of Work $ 20,000 [ ] MELD * [ l Chg. Contractor Owner Barry university, Inc. Category y [ ] Re -Issue W Address 11300 NE 2nd Avenue city Miami Shores FL Z 33138 �' State p [ ] MELE � [ ] Re -stamp C [ ] MLPG � W Phone 305-899-3790 [ ] MMEC [ ]Revision �$ Last four digits (4) of [� ] FIRE [ ] Not Applicable for C Fire Owner's Social Security No. Name Gabriel Rodriguez Name 750 NE 96th Street Address Address z d rp City Miami Shores State FL Zip 33138 {amu z City State Trp Id Phone 305-389-0065 a W Phone I am requesting a Special Request Plan Review (SRI) to be scheduled as soon as possible at the rate of $190 for the first hour and g g a $65 per each addition hour in addition to the review fees. Minimum charge one-hour. T W 19` Request: Date: lu 2nd Request: Date: 3`d Request: Date: z I am requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discipline. Additional review fees may apply. 4 1" Request: Date: OE 2nd Request: Date: 3`d Request: Date: Y:lFmm =0102 MuW qW Pemil APPM fim1b. lo SYNALOVSK[ROMAN IKSAYE AO-itctu •Plo,Iixg-Lr:rrivU+xkc+r April 17, 2014 Miami Shores Village c/o Building Department 10050 N.E. 2nd Avenue Miami Shores, Florida 33138 - RE: Barry University —Lavoie Hall —East Second Floor Renovation 11300 NE Second Avenue Permit No. CC 14-663 To Whom It May Concern: As the Architect of Record, we offer the following as clarification as it relates to the Building Department Comments issued to date for the Lavoie Hall East Second Floor Renovation (CC 14-663) Building Critique dated 04/07/14 - Ismael Naranjo Q1. Fire and DERM approval is required. R1. Comment has been noted and will be provided. Q2. Specify the connections of the metal track both for the top and bottom tracks. R2. See drawing 11 on sheet A-201. Q3. Window replacement notes on sheet A-201, note 8 makes reference to detail 9/A201, however detail 9/A201 is for cabinets. R3. Note 8 has been updated to reflect the proper detail. Q4. Provide interior finish schedule as required under chapter 8 of FBC 2010. R4. See drawing 4 on sheet A-301. Note has been added to represent specifications. Plumbing dated 04/01/14 — Osvaldo Diaz Q1. Provide plumbing plans for sink, water heater, piping, etc. R1. No sink or water heater part of scope. Mechanical Critique dated 04/07/14 — Jan Pierre Perez Q1. Missing permit application. R1. General contractor to handle. SYNALOVS KI R O MANI KSAYE An3nbrchure - Plcantrrzg - Cnkrar Devgn 1800 Eller Olive, Suite 500 - Fore tauderdaie, FE 33316 T e54,961.6806 • F 9-54,9616807 - wrwwsynalovski.com Electrical Review dated 04/07/14 Q1. Need permit application. R1. General Contractor to handle. Please feel free to contact our office should you have any further questions. Merrill Romanik, AIA Project Architect SYNALOVSKi RoMANT KSAYE Ard4itacture • Pfmviit�V • Inlevor Desigrc 1800 Ellet Drive, Suite 500 • Fort Lauderdale, FL 33316 T 954,961,6806 • F 954.961-6807 • www.slynalovski.com FIRE ENGINEERING & WATER SUPPLY BUREAU 11805 SW 26 STREET, SUITE 150, MIAMI, FL. 33175 TELEPHONE (786) 315-2771 .www.miamidade.gov/mdfr FIRE ALARM REVIEW DISAPPROVAL COMMENTS DATE: JUNE 03, 2014 REVIEW BY: FRANK D PROCESS No: M2014007993 diazo miamidade. 786 315 2797 NAME OF PROJECT: BARRY UNIVERSITY, ADDRESS: 11300 NE 2ND. AVE. PROVIDE RESPONSE SHEET, INDICATING WHERE THE CHANGES HAVE BEEN MADE. CLOUD, FLAG AND DATE ALL REVISIONS ON NEW PAGES, KEEP OLD PAGE WITHIN THE SET, JUST FOR REFERENCE & INSERT NEW PAGES ON TOP OF THE OLD ONES. 1. WE ASSUMED THE BUILDING IS NOT PROVIDED WITH FIRE ALARM AND FIRE SPRINKLER SYSTEM. IF SO, INDICATE ON PLANS, OTHERWISE PROVIDE CONCEPTUAL DRAWINGS INDICATING EXISTING, RELOCATED AND NEW DEVICES. 2. INDICATE THE REHAB. CLASS IN ACCORDANCE WITH FFPC 101 CHAPTER 43. IT LOOKAS• LIKE A RECONSTRUCTION, PLEASE CLARIFY ON PLANS. 0 0• • • • 3. CORRECT OCCUPANT LOAD CALCULATION PROVIDED ON PAGE A-201. *469SC.FT. ••• FOR CONFERENCE ROOMS 120 & 108 AND RECEPTIONS 117 & 121. *00:00 • • 4. CORRECT COMMON PATH OF TRAVEL FROM EXISTING OFFIC E #4. MAX ALIL;O 1lED • 75',FFPC 101 TABLE 4.7.6. �••••. '. 5. STORAGE ROOM 118 TO BE PROVIDED WITH 1 HR FIRE RATED ENCLOSURe?FPC 101:38.3.2.1 WITH 45 MIN. DOOR 118 PROVIDED WITH SELF CLOSING DEVICF.'PROVIDE . UL WALL. ASSEMBLY DETAILS AND PROVIDE PERMANENT MARK ABOVE ICEILING, BOTH SIDES OF FIRE RATED PARTITIONS TO COMPLY WITH FFPC 101:8.3:2.4:: 6. PROVIDE 1 HR. SEPARATION FOR NEW CORRIDORS 122 & 123 AS PER FFPC 101:38.3j8••:• AND EXISTING BREEZE WAY, FFPC 101:7.5.3.3 UNLESS TO COMPLY WITH%FPC, .... 101:38.3.6(2) 00:0 7. IF BUILDING WILL BE IN USE DURING CONSTRUCTION, EXPLAIN HOW TO COMPLY WITH FFPC 101:4.6.11.1, FFPC 1:16.4.2.1 & NFPA 241. PROVIDE DETAILS FOR REQUIRED BARRIER IF NEEDED, OTHERWISE INDICATE ON PLANS. 8. CORRECT REDMARKS ON OFFICE COPY SET PAGE A-201 9. MECHANICALLY REPRODUCE CORRECTIONS (I.E. NEW SHEETS) AND RETURN ALL PREVIOUSLY REVIEWED VOID SHEETS FOR COMPARISON. RESUBMIT PLANS FOR "DROP-OFF" FOR REWORK (For questions, concerns, or clarification on disapproval comments, you must schedule a Design Professional Appointment. Appointments are held on Monday's & Thursday's only. Appointments shall be scheduled the previous working day of the appointment between the hours of 8:30 am and 4:30 pm by calling 00.0.0 •00000 0 0 0000. 00000 0000.. 0 000000 0 0 • 0000• • 0000 .. . 6969 . 0000.. 0000.. • . . • 0.6066 0000.. . . .. .. .. .. • 000096 . . 0000.. . . 0000. 6.6. .. • . 0000. 0000 .. 6 0000...9060. • . 600.9. 6• 9966.6 .0 . 000 6 . • . 00.9 000000 786-315-2771 or logging in to www.miamidade.gov/building Please know the reviewer's name and Dade County Process # You may now visit the Miami Dade Building Department's website and view the following: • Track and check status and of Plans Review. • View disapproval comments. • Schedule a Design Professional Appointment for reworks. www.miamidade.gov/building You also may visit the Miami Dade Fire Rescue website and view the following: Submittal Application Pre -Submittal Checklist Useful Resources/Guidelines Fee Schedule www.miamidade.gov/mdfr see* 0000 00000 ... 00 000000 0000.. 0000.. 00006. 0000 00 • • • 0 • : •000 0000. 0000 . . ••..• 0000.. .. • • ... .. 000000 0000.. • ... . 0000.. :000* •00• : 0000 0000 0000 0000.. . 00.0.0 000.0. • 0000.. 0000 • 0000 .. 000 0. . 0000 .. • 0000.. 0000.. 0000.. .. 0000.. • � •04, 0... • 0000.. )")Zo`S 05V7 � NOTE: ALL SHEET MUST BE REVIEWED MIAMI-DADE COUNTY DEPARTMENT OF REGULATORY AND ECONOMIC RESOURCES Herbert S. Saffir Permitting and Inspection Center 11805 SW 26th Street (Coral Way) 9 Miami, Florida 33175-2474 • (786) 315-2000 APPLICATION FOR MUNICIPAL PERMIT APPLICANTS THAT REQUIRE PLAN REVIEW FROM MIAMI-DADE FIRE RESCUE AND/OR ENVIRONMENTAL SERVICES PROVIDE MUNICIPAL PROCESS NUMBER HERE JLJ F Job Address 41310 N F_ Z- A -J IF Contractor No. LL Z W Folio Mz a Last four (4) digits of Qualifier No. o v Contractor Name 89 Lot Block � o Qualifier Name o g a Subdivision PBpg v z Address City State _Zip Metes and bounds [ ] New Construction on [ ] Demolish V, Current use of property `,� rl I £� �� a F Vacant Land [ ] Shell Only U. z LU [ ] Alteration Interior [ ] Addition Attached Description of Work (2 Lo V Le, t 0-f) w 2° [ ] Alteration Exterior [ ] Addition Detached a [ ] Relocation of Structure [ ] Re -Roof Sq. Ft. Units Floors Enclosure [ ] Foundation Only g [ ] Repair [ ] Tent [ ] Repair Due to Fire Value of Work Q(I MBLD" [ ] Chg. Contractor Owner I v- n-1 co l l tai' Address IJ -3.06 a ee�� 11 Category [ ] Re-Issuea W [ ] MELE N [ ] Re -Stamp z City Mime Z State E!� Zip S31 �c [ ] MLPG Revision z Phone Last four (4) digits of a [ ] MMEC [ ] Not Applicable for 3 [ ] FIRE Fire Owner's Social Security No. N ° Name W Owner Permit Expeditors Priority z a 0 a. Address 21021 NE 31 Ave LU z Address Y City Aventura. Flatafe180 Zip v z City State _Zip W asOr Phone-��2�•7�� ' W a Phone I am requesting a Special Request Plan Review (SRI) to be scheduled as soon as possible at the rate of $209 for the first hour g= M and $71.50 per each additional hour in addition to the review fees. Minimum charge one-hour va.N M w � 1' Request: Date: w W ¢ 2nd Request: Date: 31d Request: Date: I am requesting Optional Plan Review (OPR) to be scheduled as soon as possible at the rate of $75 for each discipline. Additional review fees may apply. 0 o � 111 Request: Date: OE 2"d Request: Date: 31d Request: Date: Ite 12331-192 4/14 CATEGORY BUILDING BUILDING PERMIT CATEGORIES DESCRIPTION PERMIT TYPE 01 GENERAL BUILDING -COMMERCIAL MBLD 02 SUB -GENERAL BUILDING -RESIDENTIAL MBLD 08 CANVAS AWNING MBLD 10 COMMUNICATION TOWER MBLD 15 DEMOLITION MBLD 29 METAL AWNING & STORM SHUTTER MBLD 48 SCREEN ENCLOSURES MBLD 55 SWIMMING POOL MBLD 56 TENNIS COURTS (SURFACE PAVING) MBLD 86 TRAILER TIE DOWN MBLD 88 WALK-IN COOLER MBLD 91 MARINAS MBLD 92 LOW SLOPE APPLICATIONS (GRAVEL, SMOOTH FIRE MODIFIED, SINGLE PLY) MBLD 95 SHINGLES (ASPHALT, FIBERGLASS) MBLD 96 SHINGLES (METAL ROOFS/WOOD SHINGLES & SHAKE) MBLD 97 STAGE 2 VAPOR RECOVERY SYSTEM MBLD 99 SOIL IMPROVEMENT MBLD 0100 BULK STORAGE PROPANE TANK MBLD 0101 REMOVABLE STORM PANELS MBLD 0107 TILE ROOF MBLD 0110 WATER MAIN MBLD 0111 SITE PLAN MBLD 0112 INDOOR EVENT/EXHIBIT MBLD ELECTRICAL 04 FIRE ALARM SPECIALTY MELE 16 SPECIALTY WIRING MELE 38 GENERATORS MELE LPGX 01 LIQUEFIED PETROLEUM GAS MLPG 02 MISCELLANEOUS MLPG 04 LIQUEFIED PETROL. GAS/STATE MLPG MECHANICAL 09 ABOVE/BELOW GROUND TANKS/PUMPS & POLLUTANT STORAGE SYSTEM MMEC 38 COMMERCIAL HOODS MMEC 43 FIRE CHEMICAL MMEC 46 SPRAY BOOTHS MMEC 48 SMOKE CONTROL MMEC 52 RESIDENTIAL ELEVATOR MMEC FIRE 32 FIRE SPRINKLER FIRE �rtia�o, Florida Department of "'1®Qi4DE FLOR A Environmental Protection Miami -Dade DERM Division of Air Resource Management Air Quality Management Division 701 N.W. 1 st Court, 2nd Floor NOTICE OF DEMOLITION OR ASBESTOS RENOVATION Miami, Florida 33136 TYPE OF NOTICE (CHECK ONE ONLY): ❑ ORIGINAL ❑ REVISED ❑ CANCELLATION ❑ COURTESY TYPE OF PROJECT (CHECK ONE ONLY): ❑ DEMOLITION ❑ RENOVATION ❑ ROOFING IF DEMOLITION, IS IT AN ORDERED DEMOLITION? ❑ YES ❑ NO IF RENOVATION: IS IT AN EMERGENCY RENOVATION OPERATION? ❑ YES ❑ NO File # " y IS IT A PLANNED RENOVATION OPERATION? ❑ YES ❑ NO Process # 1. Facility Name Address ❑ City State Zip County Site Consultant Inspecting Site Building Size (Square Feet) # of Floors Building Age in Years Prior Use: ❑ School/College/University ❑ Residence ❑ Small Business Other Present Use: ❑ School/College/University ❑ Residence ❑ Small Business Other II. Facility Owner Phone ( ) Address City State Zip Ill. Contractor's Name Phone (� Address City State Zip Is the contractor exempt from licensure under section 469.002(4), F.S.? ❑ YES ❑ NO IV. Scheduled Dates: (Notice must be postmarked 10 working days before the project start date) Asbestos Removal (mm/dd/yy) Start: Finish: Demo/Renovation (mm/dd/yy) Start: Finish: V. Description of planned demolition or renovation work to be performed and methods to be employed, including demolition or renovation techniques to be used and description of affected facility components. Procedures to be Used (Check All That Apply): Ll Strip and Removal ❑ Glove Bag ❑ Bulldozer I ❑ I Wrecking Ball ❑ I Wet Method ❑ Dry Method ❑ Explode ❑ Burn Down OTHER: VI. Procedures for Unexpected RACM: VII. Asbestos Waste Transporter: Name Phone () Address City State Zip VIII. Waste Disposal Site: Name Address City State Zip IX. RACM or ACM: Procedure, including analytical methods, employed to detect the presence of RACM and Category I and II nonfriable ACM. Amount of RACM or ACM* square feet surfacing material square feet cementitious material linear feet pipe square feet resilient flooring cubic feet of RACM off facility components square feet asphalt roofing *Identify and describe surfacing material and other materials as applicable: I certify that the above information is correct and that an individual trained in the provisions of this regulation (40 CFR Part 61, Subpart M) will be on- site during the demolition or renovation and evidence that the required training has been accomplished by this person will be available for inspection during normal business hours. I have read and understood the additional information provided on the back of this form. (Print Name of Owner/Operator) (Signature of Owner/Operator) (Date) (Contact phone #) DERM USE ONLY Postmark/Date Received ID # 161_01-15810/10 DISTRIBUTION: White-DERM Yellow -Applicant Pink -Reserve Gold -Reserve DISCLAIMER This "NOTICE OF DEMOLITION OR ASBESTOS RENOVATION" is required pursuant to the provisions of 40 CFR 61 Subpart M and Rule 62-257'301, F;A.C. and must be submitted prior to any demolition or regulated asbestos abatement activity. This document is an Asbestos Notification only and is not a permit. This NOTICE OF DEMOLITION OR ASBESTOS RENOVATION does not constitute a waiver of or approval for any federal, state, county, or local permits that may be required for this facility. INSTRUCTIONS for COMPLETING NOTICE OF DEMOLITION OR ASBESTOS RENOVATION Y. The state asbestos removal program requirements of s. 376.60, F.S., and the renovation or demolition notice requirements of the National Emission Standards for Hazardous Air Pollutants (NESHAP), 40 CFR Part 61, Subpart M, as embodied in Rule 62-257, F.A.C., are included on this form. Check to indicate whether this notice is an original, a revision, a cancellation, or a courtesy notice (i.e., not required by law). If the notice is a revision, please indicate which entries have been changed or added. Check to indicate whether the project is a demolition or a renovation. If you checked demolition, was it ordered by the State or a local government agency? If so, in addition to the information required on the form, the owner/operator must provide the name of the agency ordering the demolition, the title of the person acting on behalf of the agency, the authority for the agency to order the demolition, the date of the order, and the date ordered to begin. A copy of the order must also be attached to the notification. If you checked renovation, is it an emergency renovation operation? If so, in addition to the information required on the form, the owner/operator must provide the date and hour the emergency occurred, the description of the sudden, unexpected event, and an explanation of how the event caused unsafe conditions or would cause equipment damage or an unreasonable financial burden. If you checked renovation and it is a planned renovation operation, please note that the notice is effective for a period not to exceed a calendar year of January 1 through December 31. I. Complete the facility information. This section describes the facility where the renovation or demolition is scheduled. This address will be used by the Department inspector to locate the project site. Provide the name of the consultant or firm that conducted the asbestos site survey/inspection. For "prior use" check the appropriate box to indicate whether the prior use of the facility is that of a school, college, or university; residence, as "residential dwelling" is defined in Rule 62-257.200, F.A.C.; small business, as defined in s. 288.703(1), F.S.; or other. If "other" is checked, identify the use. Please follow the same instructions for "present use." II. Complete the facility owner information. III. Complete the contractor information. IV. List separately the scheduled start and finish dates (month/day/year) for both the asbestos removal portion of the project and the renovation or demolition portion of the project. V. Describe and check the methods and procedures to be used for a planned demolition or renovation. Include a description of the affected facility components. (Note: The NESHAP for asbestos, which is adopted and incorporated by reference in Rule 62-204.800, F.A.C., requires obtaining Department approval prior to using a dry removal method in accordance with 40 CFR section 61.1450)(c)(0.) VI. Describe the procedures to be used in the event unexpected RACM is found or previously nonfriable asbestos .- material becomes crumbled, pulverized, or reduced to powder after start of the project. VII. Complete the asbestos waste transporter information. VIII. Complete the waste disposal site information. IX. List the amount of RACM or ACM of each type of asbestos to be removed. (Note: A volume measurement of RACM off facility components is only permissible if the length or area could not be measured previously.) Identify and describe the listed surfacing material and other listed materials as applicable. MIAMF �Florida Department of M. 1'... A Environmental Protection 10 Miami -Dade DERM w,Air Quality Management Division Division of Air Resource Managemenf ' 701 N.W. 1st Court, 2nd Floor r V NOTICE OF DEMOLITION OR ASBESTOS RENOVATION Miami, Florida 33136 TYPE OF NOTICE (CHECK ONE ONLY): ❑ ORIGINAL ❑ REVISED ❑ CANCELLATION ❑ COURTESY TYPE OF PROJECT (CHECK ONE ONLY): ❑ DEMOLITION ❑ RENOVATION ❑ ROOFING IF DEMOLITION, IS IT AN ORDERED DEMOLITION? ❑ YES ❑ NO IF RENOVATION: IS IT AN EMERGENCY RENOVATION OPERATION? ❑ YES ❑ NO File # IS IT A PLANNED RENOVATION OPERATION? ❑ YES ❑ NO Process # I. Facility Name Y Address City State Zip County Site Consultant Inspecting Site Building Size (Square Feet) # of Floors Building Age in Years t Prior Use: ❑ School/College/University ❑ Residence ❑ Small Business Other Present Use: ❑ School/College/University ❑ Residence ❑ Small Business Other It. Facility Owner Phone O Address City State Zip III. Contractor's Name Phone ( ) Address City State Zip Is the contractor exempt from licensure under section 469.002(4), F.S.? ❑ YES ❑ NO IV. Scheduled Dates: (Notice must be postmarked 10 working days before the project start date) Asbestos Removal (mm/dd/yy) Start: Finish: Demo/Renovation (mm/dd/yy) Start: Finish: V. Description of planned demolition or renovation work to be performed and methods to be employed, including demolition or renovation techniques to be used and description of affected facility components. Procedures to be Used (Check All That Apply): ❑ Strip and Removal ❑ Glove Bag ❑ Bulldozer ❑ Wrecking Ball ❑ Wet Method ❑ Dry Method ❑ Explode ❑ Burn Down OTHER: VI. Procedures for Unexpected RACM: VII. Asbestos Waste Transporter: Name Phone ( ) Address City State Zip VIII. Waste Disposal Site: Name Address City State Zip IX. RACM or ACM: Procedure, including analytical methods, employed to detect the presence of RACM and Category I and II nonfriable ACM. Amount of RACM or ACM* square feet surfacing material square feet cementitious material linear feet pipe square feet resilient flooring cubic feet of RACM off facility components square feet asphalt roofing *Identify and describe surfacing material and other materials as applicable: I certify that the above information is correct and that an individual trained in the provisions of this regulation (40 CFR Part 61, Subpart M) will be on- site during the demolition or renovation and evidence that the required training has been accomplished by this person will be available for inspection during normal business hours. I have read and understood the additional information provided on the back of this form. (Print Name of Owner/Operator) (Signature of Owner/Operator) (Date) (Contact phone #) DERM USE ONLY Postmark/Date Received ID # 161_01-15810/10 DISTRIBUTION: White—DERM Yellow—Applicant Pink—Reserve Gold—Reserve DISCLAIMER This "NOTICE OF DEMOLITION OR ASBESTOS RENOVATION" is required pursuant to the provisions of 40 CFR 61 Subpart M and Rule 62-257'301; F,A.C. and must be submitted prior to any demolition or regulated asbestos abatement activity. This document is an Asbestos Notification only and is not a permit. This NOTICE OF DEMOLITION OR ASBESTOS RENOVATION does not constitute a waiver of or approval for any federal, state, county, or local permits that may be required for this facility. 4 INSTRUCTIONS for COMPLETING NOTICE OF DEMOLITION OR ASBESTOS RENOVATION The state asbestos removal program requirements of s. 376.60, F.S., and the renovation or demolition notice requirements of the National Emission Standards for Hazardous Air Pollutants (NESHAP), 40 CFR Part 61, Subpart M, as embodied in Rule 62-257, F.A.C., are included on this form. Check to indicate whether this notice is an original, a revision, a cancellation, or a courtesy notice (i.e., not required by law). If the notice is a revision, please indicate which entries have been changed or added. Check to indicate whether the project is a demolition or a renovation. If you checked demolition, was it ordered by the State or a local government agency? If so, in addition to the information required on the form, the owner/operator must provide the name of the agency ordering the demolition, the title of the person acting on behalf of the agency, the authority for the agency to order the demolition, the date of the order, and the date ordered to begin. A copy of the order must also be attached to the notification. If you checked renovation, is it an emergency renovation operation? If so, in addition to the information required on the form, the owner/operator must provide the date and hour the emergency occurred, the description of the sudden, unexpected event, and an explanation of how the event caused unsafe conditions or would cause equipment damage or an unreasonable financial burden. If you checked renovation and it is a planned renovation operation, please note that the notice is effective for a period not to exceed a calendar year of January 1 through December 31. Complete the facility information. This section describes the facility where the renovation or demolition is scheduled. This address will be used by the Department inspector to locate the project site. Provide the name of the consultant or firm that conducted the asbestos site survey/inspection. For "prior use" check the appropriate box to indicate whether the prior use of the facility is that of a school, college, or university; residence, as "residential dwelling" is defined in Rule 62-257.200, F.A.C.; small business, as defined in s. 288.703(1), F.S.; or other. If "other" is checked, identify the use. Please follow the same instructions for "present use." Complete the facility owner information. III. Complete the contractor information. IV. List separately the scheduled start and finish dates (month/day/year) for both the asbestos removal portion of the project and the renovation or demolition portion of the project. V. Describe and check the methods and procedures to be used for a planned demolition or renovation. Include a description of the affected facility components. (Note: The NESHAP for asbestos, which is adopted and . incorporated by reference in Rule 62-204.800, F.A.C., requires obtaining Department approval prior to using a dry removal method in accordance with 40 CFR section 61.145(3)(c)(i).) VI. Describe the procedures to be used in the event unexpected RACM is found or previously nonfriable asbestos material becomes crumbled, pulverized, or reduced to powder after start of the project. VII. Complete the asbestos waste transporter information. VIII. Complete the waste disposal site information. IX. List the amount of RACM or ACM of each type of asbestos to be removed. (Note: A volume measurement of RACM off facility components is only permissible if the length or area could not be measured previously.) Identify and describe the listed surfacing material and other listed materials as applicable. a } Florida Department of MIAMIZADEME F A Environmental Protection Miami -Dade DERM a. 3. Division of Air Resource ManagemenAir Quality Management Division f ' 701 N.W. 1st Court, 2nd Floor NOTICE OF DEMOLITION OR ASBESTOS RENOVATION Miami, Florida 33136 TYPE OF NOTICE (CHECK ONE ONLY): ❑ ORIGINAL ❑ REVISED ❑ CANCELLATION ❑ COURTESY TYPE OF PROJECT (CHECK ONE ONLY): ❑ DEMOLITION ❑ RENOVATION ❑ ROOFING IF DEMOLITION, IS IT AN ORDERED DEMOLITION? ❑ YES ❑ NO IF RENOVATION: IS IT AN EMERGENCY RENOVATION OPERATION? ❑ YES ❑ NO File # 40 IS ITA PLANNED RENOVATION OPERATION? ❑ YES ❑ NO Process # I. Facility Name Address City State Zip County Site Consultant Inspecting Site Building Size (Square Feet) # of Floors Building Age in Years Prior Use: ❑ School/College/University ❑ Residence i ❑ Small Business Other Present Use: ❑ School/College/University ❑ Residence ❑ Small Business Other 11. Facility Owner f Phone ( ) Address City State Zip III. Contractor's Name Phone ( ) Address City State Zip Is the contractor exempt from licensure under section 469.002(4), F.S.? ❑ YES ❑ NO IV. Scheduled Dates: (Notice must be postmarked 10 working days before the project start date) Asbestos Removal (mm/dd/yy) Start: Finish: Demo/Renovation (mm/dd/yy) Start: Finish: V. Description of planned demolition or renovation work to be performed and methods to be employed, including demolition or renovation techniques to be used and description of affected facility components. Procedures to be Used (Check All That ADDIv): ❑ I Strip and Removal ❑ Glove Bag ❑ Bulldozer ❑ Wrecking Ball ❑ I Wet Method ❑ Dry Method ❑ Explode ❑ Burn Down OTHER: VI. Procedures for Unexpected RACM: VII. Asbestos Waste Transporter: Name Phone () Address City State Zip VIII. Waste Disposal Site: Name Address City State Zip IX. RACM or ACM: Procedure, including analytical methods, employed to detect the presence of RACM and Category I and II nonfriable ACM. Amount of RACM or ACM* square feet surfacing material square feet cementitious material linear feet pipe square feet resilient flooring cubic feet of RACM off facility components square feet asphalt roofing *Identify and describe surfacing material and other materials as applicable: I certify that the above information is correct and that an individual trained in the provisions of this regulation (40 CFR Part 61, Subpart M) will be on- site during the demolition or renovation and evidence that the required training has been accomplished by this person will be available for inspection during normal business hours. I have read and understood the additional information provided on the back of this form. (Print Name of Owner/Operator) (Signature of Owner/Operator) (Date) (Contact phone #) DERM USE ONLY Postmark/Date Received ID # 161_01-15810/10 DISTRIBUTION: White-DERM Yellow -Applicant Pink -Reserve Gold -Reserve DISCLAIMER This "NOTICE ClFDEMOLITION OQASBESTOS RENOVATION" iorequired pursuant to the provisions of4VCFR- 6l Subpart and Rule 62-257.301, FA.[. and must besubmitted prior to any demolition or regulated asbestos abatement activity. This document is an Asbestos Notification only and is not a permit. ' This NOTICE OF DEM(JL[T|(]h] OR ASBESTOS REN[yvAJ|()M does not constitute a waiver of or approval for any federal, state, county, or local permits that may be required for this facility. 0 INSTRUCTIONS for COMPLETING ° NOTICE OF DEMOLITION OR ASBESTOS RENOVATION The state asbestos removal program requirements of s. 376.60, F.S, and the renovation or demolition notice requirements of the National Emission Standards for Hazardous Air Pollutants(NESH/\P),4OCFR Part 6l,Subpart &4, as embodied in Rule 62-257, F/\.[, are included on this form. Check to indicate whether this notice is an original, a revision, a cancellation, or a courtesy notice (i.e., not required by law). If the notice is a revision, please indicate which entries have been changed or added. Check to indicate whether the project is a demolition or a renovation. If you checked demolition, was it ordered by the State or a local government agency? If so, in addition to the information required on the form, the owner/operator must provide the name of the agency ordering the demolition, the title cfthe person acting nnbehalf nf the agency, the authority for the agency toorder the demolition, the date ofthe order, and the date ordered to begin. A copy of the order must also be attached to the notification. Ifyou checked renovation, isbanemergency renovation operation? If so, inaddition tothe information required on the form, the owner/operator must provide the date and hour the emergency ocCurned, the description of the sudden, unexpected event, and an explanation of how the event caused unsafe conditions or would cause equipment damage or an unreasonable financial burden. If you checked renovation and it is a planned renovation operation, please note that the notice is effective for a period not to exceed a calendar year of January 1 through December 31. Complete the facility information. This section describes the facility where the renovation or demolition is scheduled. This address will beuscd bythe Department inspector to locate the project site. Provide the name of the consultant orfirm that conducted the asbestos site survey/inspection. For "prior use" check the appropriate box to indicate whether the prior use of the facility is that ofa school, college, or university; residence, as "residential dwelling" is defined in Dulc62'Z57.2O0, [/\.[.; small business, as defined in s. 288.703(l), F5.; or other. If "other" is checked, identify the use. Please follow the same instructions for "present use." Complete the facility owner information. Ui Complete the contractor information. |\( List separately the scheduled start and finish dates (month/day/year) for both the asbestos removal portion of the project and the renovation or demolition portion of the project. V. Describe and check the methods and procedures to be used for u planned demolition or renovation. Include a description of the affected facility components. (Note: The NESH/\Pfo, asbestos, which is adopted and ^. incorporated by reference in Rule 62-204.800, F./\.C., requires obtaining Department approval prior to using adry removal method inaccordance with 40CFR section 6l.145(])(c)(i).) ^- V|. Describe the procedures to he used in the event unexpected RA[M is found or previously nonfriohlnasbmsbos material becomes crumbled, pulverized, or reduced to powder after start ofthe project. VU. Complete the asbestos waste transporter information. VIII. Complete the waste disposal site information. |X. List the amount ofKA[MorACM ofeach type ofasbestos to[eremoved. (Note: Avolume measurement of QA[M off facility components is only permissible if the length or area could not be measured previously.) Identify and describe the listed surfacing material and other listed materials as applicable. e,1 Florida Department ofma A Environmental Protection Miami -Dade DERM s_ Air Quality Management Division Division of Air Resource Managemenf . 701 N.W. 1st Court, 2nd Floor NOTICE OF DEMOLITION OR ASBESTOS RENOVATION Miami, Florida 33136 TYPE OF NOTICE (CHECK ONE ONLY): ❑ ORIGINAL ❑ REVISED ❑ CANCELLATION ❑ COURTESY TYPE OF PROJECT (CHECK ONE ONLY): ❑ DEMOLITION ❑ RENOVATION ❑ ROOFING IF DEMOLITION, IS IT AN ORDERED DEMOLITION? ❑ YES ❑ NO IF RENOVATION: IS IT AN EMERGENCY RENOVATION OPERATION? ❑ YES ❑ NO File # IS ITA PLANNED RENOVATION OPERATION? ❑ YES ❑ NO Process # I. Facility Name Address City State Zip County Site Consultant Inspecting Site Building Size (Square Feet) # of Floors Building Age in Years Prior Use: ❑ School/College/University ❑ Residence ❑ Small Business Other Present Use: ❑ School/College/University ❑ Residence ❑ Small Business Other 11. Facility Owner Phone ( ) Address City State Zip 111. Contractor's Name Phone ( ) Address City State Zip Is the contractor exempt from licensure under section 469.002(4), F.S.? ❑ YES ❑ NO IV. Scheduled Dates: (Notice must be postmarked 10 working days before the project start date) Asbestos Removal (mm/dd/yy) Start: Finish: Demo/Renovation (mm/dd/yy) Start: Finish: V. Description of planned demolition or renovation work to be performed and methods to be employed, including demolition or renovation techniques to be used and description of affected facility components. Procedures to be Used (Check All That Apply): F-1Strip and Removal ❑ Glove Bag ❑ Bulldozer E:1Wrecking Ball [-]I Wet Method ❑ Dry Method I ❑ I Explode ❑ I Burn Down OTHER: VI. Procedures for Unexpected RACM: VII. Asbestos Waste Transporter: Name Phone ( ) Address City State Zip Vlll. Waste Disposal Site: Name Address City State Zip IX. RACM or ACM: Procedure, including analytical methods, employed to detect the presence of RACM and Category I and II nonfriable ACM. Amount of RACM or ACM* square feet surfacing material square feet cementitious material linear feet pipe square feet resilient flooring cubic feet of RACM off facility components square feet asphalt roofing *Identify and describe surfacing material and other materials as applicable: I certify that the above information is correct and that an individual trained in the provisions of this regulation (40 CFR Part 61, Subpart M) will be on- site during the demolition or renovation and evidence that the required training has been accomplished by this person will be available for inspection during normal business hours. I have read and understood the additional information provided on the back of this form. (Print Name of Owner/Operator) (Signature of Owner/Operator) (Date) (Contact phone #) DERM USE ONLY Postmark/Date Received ID # 161_01-15810/10 DISTRIBUTION: White-DERM Yellow -Applicant Pink -Reserve Gold -Reserve DISCLAIMER This "NOTICE OF DEMOLITION OR ASBESTOS RENOVATION" is required pursuant to the provisions of 40 CFR - 61 Subpart M and Rule 62-257:301; F,A.C. and must be submitted prior to any demolition or regulated asbestos abatement activity. This document is an Asbestos Notification only and is not a permit. This NOTICE OF DEMOLITION OR ASBESTOS RENOVATION does not constitute a waiver of or approval for any federal, state, county, or local permits that may be required for this facility. INSTRUCTIONS for COMPLETING NOTICE OF DEMOLITION OR ASBESTOS RENOVATION The state asbestos removal program requirements of s. 376.60, FS., and the renovation or demolition notice - requirements of the National Emission Standards for Hazardous Air Pollutants (NESHAP), 40 CFR Part 61, Subpart M, as embodied in Rule 62-257, F.A.C., are included on this form. Check to indicate whether this notice is an original, a revision, a cancellation, or a courtesy notice (i.e., not required by law). If the notice is a revision, please indicate which entries have been changed or added. Check to indicate whether the project is a demolition or a renovation. If you checked demolition, was it ordered by the State or a local government agency? If so, in addition to the information required on the form, the owner/operator must provide the name of the agency ordering the demolition, the title of the person acting on behalf of the agency, the authority for the agency to order the demolition, the date of the order, and the date ordered to begin. A copy of the order must also be attached to the notification. If you checked renovation, is it an emergency renovation operation? If so, in addition to the information required on the form, the owner/operator must provide the date and hour the emergency occurred, the description of the sudden, unexpected event, and an explanation of how the event caused unsafe conditions or would cause equipment damage or an unreasonable financial burden, If you checked renovation and it is a planned renovation operation, please note that the notice is effective for a period not to exceed a calendar year of January 1 through December 31. I. Complete the facility information. This section describes the facility where the renovation or demolition is scheduled. This address will be used by the Department inspector to locate the project site. Provide the name of the consultant or firm that conducted the asbestos site survey/inspection. For "prior use" check the appropriate box to indicate whether the prior use of the facility is that of a school, college, or university; residence, as "residential dwelling is defined in Rule 62-257.200, F.A.C.; small business, as defined in s. 288.703(1), F.S.; or other. If "other" is checked, identify the use. Please follow the same instructions for "present use." Complete the facility owner information. III. Complete the contractor information. IV. List separately the scheduled start and finish dates (month/day/year) for both the asbestos removal portion of the project and the renovation or demolition portion of the project. V. Describe and check the methods and procedures to be used for a planned demolition or renovation. Include a description of the affected facility components. (Note: The NESHAP for asbestos, which is adopted and incorporated by reference in Rule 62-204.800, F.A.C., requires obtaining Department approval prior to using a dry removal method in accordance with 40 CFR section 61.145(3)(c)(i).) VI. Describe the procedures to be used in the event unexpected RACM is found or previously nonfriable asbestos material becomes crumbled, pulverized, or reduced to powder after start of the project. VII. Complete the asbestos waste transporter information. VIII. Complete the waste disposal site information. IX. List the amount of RACM or ACM of each type of asbestos to be removed. (Note: A volume measurement of RACM off facility components is only permissible if the length or area could not be measured previously.) Identify and describe the listed surfacing material and other listed materials as applicable.