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Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores,Florida 33138
Tel: (305)795-2204 Fax:(305)756-8972
Website:www.miamishoresvillaee.com
TEMPORARY CERTIFICATE OF OCCUPANCY APPLICATION (T.C.0)
Please be advised that the TCO expiration date is based on conditions from Miami-Dade County Fire Dept.
Date: '444-
Folio#: 11-
Master Building Permit#: eG 3'/$�` �ZZ Square Footage of Space: 11700
Miami-Dade Municipal Process#: (Nl201�DDS(2 Miami-Dade Municipal Permit#: 20/� -o�t/1o77
Contracting Company: -�L /4/j`-ell Io
Owner/Tenant:
Lot: Block:: Subdivision:
Street Address: l3r�D ?J AV4
Signature of applicant verifies the above information is true and correct.The Temporary Certificate of Occupancy is issued to the
above named for building at the above location only upon the express provisions that the applicant will be able by and comply
with all conditions of the Zoning ordinances and all ordinances of Miami Shores Village and/or Florida Building Code pertaining to
erection,construction or remodeling of buildings or structures. This also certifies that the electrical wiring and or equipment,and
the plumbing work has been inspected and approved.
l`v"
Print Name of Applidant or QualifierS gnature o plicant or Qualifier
FOR OFFICE USE ONLY
TCO Number: Fee:
Expiration Date: Technology Fee:
Approved Use for Occupancy: Total:
Remarks:
Building Official/Designee:
Inspections:
Zoning Yes/No Plumbing Yes/No
Building Yes/No Fire Sprinkler Yes/No
Electrical Yes/No Fire Yes/No
Mechanical Yes/No
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
UNIFORM MUNICIPAL TCO/TCC INSPECTION REPORTING FORM
Master Permit No. Miami-Dade County
from Municipality: "��r J Z� Municipal Permit No. (MBLD): 2D�S o3 q6 77
Job Address: 0300 N6 IJ Arc Unit: Project Name: ?�ovsu
Qualifier's Name: r V1 AW. Qualifier's Phone: 3b5 qqq Rgd( Email: :r-V,`lAe c,ee vvo.
Owner's Name: &c. Owner's Phone: 305 91q 700ig Email: S6-lw I z
This Uniform Municipal TCO/TCC Inspection Reporting Form is used to gather trade approvals for Temporary Certificate of
Occupancy(TCO) or Completion (TCC). Once validated by the Municipal Building Department personnel,the form must be
present at the job site for the field inspectors. When all approvals have be n obtained, take the signed form back to the
Municipal Building Department for TCO/TCC issuance.
OForm Validated by !"-„4� Date:
Bldg Dept Personnel: Print Name Signature
5All "Required"TCO/TCC inspections indicated below must be signed "Approved" before certificate issuance.
Inspector's Approval
Req'd. Trade Date Comments
Name Si re
wilding -�
Electrical
Fire �� CG �Z� NP'e S
❑ ,,Mechanical
Plumbing �.D��� /Sy C.ei. P/, .
❑ Public Works
❑ Zoning
❑ Other
Important Note: The TCO/TCC is not valid and building and/or space may not be occupied unless signed by the Building
Official. Occupying the building and/or space without obtaining a TCO/TCC issued by the Municipal Building Department is
prohibited and is in violation of th a ing Code Section 110.3.
OBuilding Official's Approval U Date: r O T I
TCO/TCC ❑ Extension TCC/TCO Duration:
Conditions of TCO/TCC:
• If Master Permit expires,the TCO/TCC will automatically be revoked and the space must be vacated.
• A TCO/TCC may be revoked if any action by the contractor, owner or tenant creates any code violation affecting the proper
occupancy of the area.
• Any TCO/TCC that expires without renewal or has been revoked can result in a notice of violation, civil violation and/or
disconnection of utility services.
• Other conditions:
04/09D I.OSFBOA
0 H L Miami Lake Worth
ti Vis;
Arellano Orlando Jacksonville
Miami Dade Pr Fire R"cus ®apartment
evenDivIsion
New Const uctiontion lnspection Bureau
TCO APPIJOVED
Permit#CC-3-15-522 "�` " '
� l
Address 11300 NE 2nd Ave.: Roussell Dining Hall Renovation SIGNATURE DAT
Reason for TCO: Pending Miami-Dade Fire Department Review of Revised Life Safety Plan,Sheet A1.02 (changes to
plan include location of Max Occupancy Load Sign and Location of Handicap Seating)
Areas included in TCO Request: Roussell Dining Hall and Bathrooms
Duration of TCO:30 Days
.tisc
Contact: Fernando Gayo (Cell)786-282-1544/Bernie Perez Jr.326-608-1091
We hereby hold harmless and release Miami Shores Village Building Department and Miami-Dade Fire Department
while under the
from an liability that may arise during the use of designated areas in the aforementioned facility w e d
Y tY Y g g tY
limitation of the Temporary Certificate of Occupancy.
We hereby certify that all means of egress shall be kept clear and accessible and that all life safety systems will be
maintained and operable at all times while the building is being occupied.
Sinc
Fran Vilar
CGC1 22283
Arellano Construction Co. - www.arellanogc.com
7051 SW 12th Street, Miami, FL 33144 - Phone: 305.994.9901 - Fax: 305.994.9903
n_a
MIAMI-DADE COUNTY FIRE RESCUE
FIRE PREVENTION DIVISION
' •� �`'�� TEMPORARY CERTIFICATE OF OCCUPANCY(T.C.0)
STATUS FORM
e.
Municipal Permit#: Miami-Dade Process#
Miami-Dade Permit#: 2015034677 Owner/Contractors Name:
Business Name: ROUSSELL DINING HALL Owner/Contractor Phone#:
Contact Name: FRANK VILAR Phone# 786-282-1544
Address: 11300 NE 2 AVE
City: MIAMI SHORES State: FL Zip Code: 33161
REASON
PLAN REVISION AND 2 EM LIGHTS INOP ARE ONLY ITEMS PENDING .
Length: 10130 Days E]60 Days 10,90 Days Other(# of days)
�.. MIT _,..
Required: Yes 0 No
RESTRICTIONS/COMMENTS (If Applicable)
TCO RECOMMENDED
SUBSIDIARY PERMITS (Fre Alarm,Sprinkler,etc.)
NOTE: Submit this completed TCO Status form with a TCO Hardship letter(not applicable for municipalities), Fire Inspection Report,and a
TCO Application from Miami-Dade County Building or Municipality Building Department to The Fire Prevention New Construction Bureau OIC
or designee for approval.
LT. Wray 08/13/2015
Inspector's Signature DATE
LT—PF5r 1 l
--
OIC's Signature DATE
MIAMhQADE
e
Rev 4-2014 Crook
MIAMI-DADE FIRE RESCUE DEPARTMENT DATE
FIRE INSPECTION REPORT CONTINUATION
OCCUPANT ADDRESS
45PA AAA
300 oyl
}
t
1
Page of INSPECTOR L T
125 01-105 3/08
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
Website:www.miamishoresvillage.com
TEMPORARY CERTIFICATE OF OCCUPANCY APPLICATION (T.C.0)
Please be advised that the TCO expiration date is based on conditions from Miami-Dade County Fire Dept.
Date: �S Folio#:11-
Master Building Permit#: et'-' 3'/5�' �ZZ Square Footage of Space: )DOD
Miami-Dade Municipal Proce��sss#: VI�ZOI�D/D��27i�'( Miami-Dade Municipal Permit#: 2O1r'��°Ilo�7
Contracting Company: �'`7L l/j`ella !o
Owner/Tenant:
Lot: Block: /� Subdivision:
Street Address: )13CO � 7k) AV4
Signature of applicant verifies the above information is true and correct.The Temporary Certificate of occupancy is issued to the
above named for building at the above location only upon the express provisions that the applicant will be able by and comply
with all conditions of the Zoning ordinances and all ordinances of Miami Shores Village and/or Florida Building Code pertaining to
erection,construction or remodeling of buildings or structures. This also certifies that the electrical wiring and or equipment,and
the plumbing work has been inspected and approved.
Print Name of Appl nt or QualifierS gnature o pllcant or Qualifier
FOR OFFICE USE ONLY
TCO Number: Fee:
Expiration Date: Technology Fee:
Approved Use for Occupancy: Total:
Remarks:
Building Official/Designee:
Inspections:
Zoning Yes/No Plumbing Yes/No
Building Yes/No Fire Sprinkler Yes/No
Electrical Yes/No Fire Yes/No
Mechanical Yes/No
4 , } Miami Shores Village
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972
UNIFORM MUNICIPAL TCO/TCC INSPECTION REPORTING FORM
Master Permit No. r Miami-Dade County
from Municipality: (t 3_�J—5Zz Municipal Permit No.(MBLD): Z�fs�3 q1
Job Address: 0300 IVB IJ AVC Unit: Project Name: ?�Qvsscll � ir. W1
Qualifier's Name: r vAwr Qualifier's Phone: 365 q94 Rgd( Email: f-Vila,r �(�j c.•e.ovvl.
Owner's Name: �u+y c� Owner's Phone: 305 3117000 Email: TA w c (
z
This Uniform Municipal TCO/TCC Inspection Reporting Form is used to gather trade approvals for Temporary Certificate of
Occupancy(TCO)or Completion (TCC). Once validated by the Municipal Building Department personnel,the form must be
present at the job site for the field inspectors. When all approvals have be n obtained,take the signed form back to the
Municipal Building Department for TCO/TCC issuance.
1 Form Validated by /!a� Date:
Bldg Dept Personnel: Print Name Signature
OAll "Required"TCO/TCC inspections indicated below must be signed "Approved" before certificate issuance.
Req'd. Trade Inspector's Approval Date Comments
Name Signature
"Buil ing
EK Electrical
Fire
❑ ,Mechanical
Plumbing
❑ Public Works
❑ Zoning
❑ Other
Important Note: The TCO/TCC is not valid and building and/or space may not be occupied unless signed by the Building
Official. Occupying the building and/or space without obtaining a TCO/TCC issued by the Municipal Building Department is
prohibited and is in violation of the Florida Building Code Section 110.3.
OBuilding Official's Approval: Date:
❑ 1s`TCO/TCC ❑ Extension TCC/TCO Duration:
Conditions of TCO/TCC:
• If Master Permit expires,the TCO/TCC will automatically be revoked and the space must be vacated.
• A TCO/TCC may be revoked if any action by the contractor, owner or tenant creates any code violation affecting the proper
occupancy of the area.
• Any TCO/TCC that expires without renewal or has been revoked can result in a notice of violation, civil violation and/or
disconnection of utility services.
• Other conditions:
04/09D I.OSFBOA
o O H L Miami Lake Worth
:oo a;4 Orlando Jacksonville
.__asAa Are lla n o
Permit#CC-3-15-522
Address 11300 NE 2nd Ave.: Roussel[ Dining Hall Renovation
Reason for TCO: Pending Miami-Dade Fire Department Review of Revised Life Safety Plan,Sheet A1.02 (changes to
plan include location of Max Occupancy Load Sign and Location of Handicap Seating)
Areas included in TCO Request: Roussell Dining Hall and Bathrooms
Duration of TCO: 30 Days
Contact: Fernando Gayo (Cell) 786-282-1544/Bernie Perez Jr.786-608-1091
We hereby hold harmless and release Miami Shores Village Building Department and Miami-Dade Fire Department
from any liability that may arise during the use of designated areas in the aforementioned facility while under the
limitation of the Temporary Certificate of Occupancy.
We hereby certify that all means of egress shall be kept clear and accessible and that all life safety systems will be
maintained and operable at all times while the building is being occupied.
Sin
h
Fran Vilar
CGC 522283
Arellano Construction Co. - www.arellanogc.com
7051 SW 1211 Street, Miami, FL 33144 - Phone: 305.994.9901 - Fax: 305.994.9903
MIAMI-DADE FIRE RESCUE DEPARTMENT DATE
FIRE INSPECTION REPORT CONTINUATION
OCCUPANT ADDRESS 113 DD N C.
t
opS
MAO,
3Gnu&,
° 4
.t
4
Page ( of : INSPECTOR
125_01-105 3/08
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