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ELC-15-1287 y Pe' ;,. p8'CTI'T airial ; Miami Shores Village 10050 N.E.2nd Avenue NE Miami Shores,FL 33138-0000 Phone: (305)795-2204 x a ` s , 7 Expiration: 01/12/2016 Project Address Parcel Number Applicant 11300 NE 2 Avenue Number: Landon Studen 1121360010160-32 BARRY UNIVERSITY INC Miami Shores, FL 33138-0000 Block: Lot: 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 Valuation: $ 33,000.00 ROAD RUNNER ELECTRIC INC (305)267-1013 .. . .....: , ......._:. __:..... . _....:._,... Total Sq Feet: 0 Type of Work:INTERIOR RENOVATION ELECTRICAL WORK Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Scanning:1 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical Underground W.W. Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $19.80 Invoice# ELC-5-15-55750 DBPR Fee $14.85 05/28/2015 Credit Card $50.00 $1,025.50 DCA Fee $14.85 Education Surcharge $6.60 07/16/2015 Credit Card $ 1,025.50 $0.00 Permit Fee $990.00 Scanning Fee $3.00 Technology Fee $26.40 Total: $1,075.50 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 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. Futhermore,I authorize the above-named contractor to doh ork stated. July 16, 2015 Authorized Signature:Owner / Applicant / Contractor / Ag en a e Building Department Copy July 16,2015 1 Miami Shores Village RECTFV Building Department MAA120'51 10050 N.E.2nd Avenue,Miami Shores,Florida 33138BY; Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 (d BUILDING Master Permit No. CC.-3-15 -16ZZ PERMIT APPLICATION Sub Permit No-tl is— ❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑EXTENSION ❑RENEWAL PLUMBING ❑MECHANICAL [-]PUBLICWORKS CHANGE OF ❑CANCELLATION ❑SHOP CONTRACTOR DRAWINGS JOB ADDRESS: \k%W U-r- 1&r kVi=_ City. Miami Shares County Miami Dade zip., Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load:_Construction Type: ` Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Tiitntleholder)._�1c�.Rtt1h V AlAgar l Phone#: Address: \\-i1 V�6 '4,;- QvE city: _ NVPIW�' State: F-1_. Zip: 2S%%6k Tenant/Lessee Name: Phone# Email: CONTRACTOR:Company Name:S?jW- r � Phone#: SQ'&-UA-AWG Address: �M!a S v5 '-*+A A�Lr,- City: M%KW State:- F1a zip: 33155 Qualifier Name: `��. S• Phone# ?"r'-'1l0�-101'3 State Certification or Registration#: 0 n%& Certificate of Competency#: DESIGNER:Architect/Engineer. Phone#: Address: City: State Zip: Value of Work for this Permit:$4;M000 Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition l Description of Work: Specify color of color thru tile: ,,ms�ss Submittal Fee Permit Fee$ '7z0 <�� CCF$ to/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ 2 (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State 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 comm cement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. t e absence of such pasted notice, the Inspection will not be approved and a reinspection fee will be charged. Signature Signature OWNER or AGENT CONTRACTOR The foregoing Instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 11—day of— by LT. _rte da of ZO 19 by L, Pi t t' .who is Jrsonally kn n to P. who rsanally kno to me or who has produced as me or who has produced as identification and who did take an oath. identification a ld an ath. NOTARY PUBLIC: NOTARY PU Sign: Sign: Print• Print Sea: .►0N NPuSb dFlda al WeORTIZ Dennis Smith Se : y�1iEE 8517 My ComssbEE 84684 E(pwm Namm 28.2016� Ezpbes 03117/2017WM Iron Ndwy R&9c uhbmbm 15O!4 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Rev1sed02/24/2014) 'fail Miami Shores Village Building Department R 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. COPY OF QUALIFIER'S STATE LICENCES B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATEOMPETEN 0 F Y: C C A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Certificate must specify the description of operations or contractor license number. ■rrrrr�rrrr�rrrrarrrrr�r■ ■r�rrrrrrrrrr�rr���r�rrrr�rr�rrrrrrr�rrrrrrrrrr��rr�rrrrrrrrrrr� BUSINESS NAME: Is BUSINESS ADDRESS: ��Lj% Sw 'j�A k-A� CITY ���� STATES ZIP � `r BUSINESS PHONE: (Ig-Ij '110 _\Q'\a FAX NUMBER ®ca D61r \��L% CELL PHONE(_) QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: Vvv •v" r\tlV LAVVJVN, J1_—L.Kt1AKY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION �: `F • ELECTRICAL CONTRACTORS LICENSING BOARD ay X53,td{E �i � sa The ELECTRICAL CONTRACTOR "��A ` Named below IS CERTIFIED . . Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 SUAREZ,ALBERTO P ROAD RUNNER ELECTRIC INC. 4735 SW 74 AVE MIAMI FL 33155 ISSUED: 07/24/2014 DISPLAY AS REQUIRED BYLAW SEQ# L1407240001883 102376 Local Business Tax Receipt Miami-Dade County, State of Florida —THIS IS NOTA BILL — DO NOT PAYTj 3302387 L B BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES ROAD RUNNER ELECTRIC INC RENEWAL SEPTEMBER 30, 2015 4735 SW 74 AVE 3439797 Must be displayed at place of business MIAMI FL 33155 Pursuant to County Code Chapter 8A-Art.9&10 OWNER SEC.TYPE OF BUSINESS PAYMENT RECEIVED ROAD RUNNER ELECTRIC INC 196 ELECTRICAL CONTRACTOR BY TAX COLLECTOR ` Worker(s) 4 EC0001696 $75.00 07/24/2014 CHECK21-14-034908 This Local Business Tax Receipt only confirms payment of the Local Business Tax The Receipt is not a license, permit or a certification of the holders qualifications,to do business.Holder must comply with any governmental a or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec sa-276. ' For more information,visit wvrw mlemidade gov/taxcollector s -�� ROADR01 OP ID:CP CERTIFICATE OF LIABILITY INSURANCE F DATE 05/227/20157120151r7 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(ies) 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 CONTACT FILER INSURANCE,INC. NAME: Christine Plersol 9440 S.W.77 Avenue HONEM 305-270-2161 FpNo,305-270-2195 Miami„FL 33156E-MAILSS:cplersol filerins.com Keith R.Miller INSURERCS)AFFORDING COVERAGE NAIC# INSURER A:Monroe Guarantee Ins Co 32506 INSURED Road Runner Electric Inc. INSURER B:FCCI Insurance Company 10178 4735 S.W.74 Ave. INSURER C:Bridgefield Employers Ins.Co. 10701 Miami,FL 33155-2547 INSURER D: i INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MID MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CPP0007006 01/19/2015 01/19/2016D MAG TO RENTED PREMISES Ea occurrence $ 100,000 CLAIMS MADE OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $ 2,000,00 POLICY FXI PRO-jECTLOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS PERACCIDEN $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 B EXCESS UAB CLAIMS-MADE UMB0007986 01/19/2015 01/19/2016 AGGREGATE $ 4,000,00 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION WC STATU OTH- AND EMPLOYERS'LIABILITY X TORY LIMITS X ER C ANY PROPRIETOR/PARTNER/EXECUTNE YIN 65040431 01/19/2015 01/19/2016 E.L.EACH ACCIDENT $ 1,000,00 OFFICEWMEMBER EXCLUDED? F—Y] N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 IdescrIbe yyDESCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 1,000,00 —7 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Electrical contractor. CERTIFICATE HOLDER CANCELLATION M IAM 109 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Villa a THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. 10050 N.E.2nd Avenue Miami Shores,FL 33138 AUTHORIZED REPRESENTATIVE ��IAAd'� CHRISTINE PIERSOL AM73M ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD