CC-14-1666 (2) 4
Miami Shores Village MEC
Building Department 2014
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 BY
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 20 L®
BUILDING Master Permit No.��
PERMIT APPLICATION Sub Permit No.
OBUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [–]PUBLIC WORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 11300 NE 2nd Avenue —kx:>Cs'�
City: Miami Shores County: Miami Dade zip:
Folio/Parcel#:11-2136-000-0050 Is the Building Historically Designated:Yes NO x
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder): Barry University Phone#:
Address: 11300 NE 2nd Avenue
City. Miami Shores State: FL Zip: 33138
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: �)uu- Phone#: CUs' CIC14 q-w I
Address: ��`�` 'GW \a--VkL S*
City: n� State: Zip: -5--5 I Uu
Qualifier Name: TC'AA C_V t C-(- Phone#:
State Certification or Registration#: C e° lSo���J Certificate of Competency#:
DESIGNER:Architect/Engineer: Bruns-Pak Phone#: 732-2484455
Address: City: State Zip:
Value of Work for this Permit:$ a orc Square/Linear Footage of Work: 600SF
Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work: Interior Renovation consisting of demolition of existing doors, frames, hardware,
finishes, HVAC, fire protection and electrical systems to receive new layout. Converting of two rooms
into one for more data equipment space.
Specify color of color thru tile:
Submittal Fee$ 7n % 0 Permit Fee$ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE$
(Revised02/24/2014)
� a
Bonding Company's Name(if applicable) N/A
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 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 7-4 .� rc/ Signature
OWNER or AGENT CONTRACTOR
The foregoing instrument was acknowledged before a this The foregoing instr ment was acknowledged before me this
4t J210V of /�f 20 by day of 1� 20 by
1lx who is personally known toCn ' a w is personally known to
r�or who has produced as me or who has produced as
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NO
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Print: ••• N•� Print:
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APPROVEDBY 10/cPlans Examiner Zoning
Structural Review Clerk
(Revisedo2/24/2014)
` STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
CONSTRUCTION INDUSTRY LICENSING BOARD (850)487-1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399-0783
VILAR, FRANK
OHL-ARELLANO
7051 SW 12TH ST
MIAMI FL 33144
Congratuilonst With this became one of the
ate m1111on Floridians 0sed by a Department of Business and t
Professional Regulation. Our pressbrlals and businesses range STATE OF FLORIDA
from architects to yacht brokers,from boxers to barbequs restaurar►ts, DEPARTMENTOF_BUSINESS AND
and they keep Florida's economy strong. PROFESSILII AL wGULATION
Every day we work to Improve the way we do business In order to CGC1522253bt" (15119/2014
serve you better. For information about our services,please log onto
www myfloridaWwrise coin. There you can find more infomrdition CERTIFIED GENER O 41R
about our divisions and the regulations that impact you,subscribe VI .FRANK. 4.
to department newsletters and lawn more about the Departments OHL ARECLANO
Initiatives. -
our mission at the Department is:License Efticiently,Regulate Fairly.
We constanty strive to serve you better so that you can serve your
Customers. Thank you for doing business In Florida, IS CERTIFIED under the provisions of Ch.488 FS. -
and congratulations on your new Iicensel Exp dM nuo 31.2018 L14051OWM40
DETACH HERE
RICK SCOTT.GOVERNOR KEN LAWSON,SECRETARY
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
_.,
CONSTRUCTtOtI�INDU3TRY�,LICENBtNG BOARD : _
,
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The GENERAL CONTRACTOR'
Named below IS-CERTIFIED:
Under the;praviticns ofChaptec 483 FS. p
Facpirabon date: AUG,31,20016 -
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OHL ARELLANQ 71
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' AQA� CERTIFICATE OF LIABILITY INSURANCE °A���'")
THIS CERTIFICATE IS ISSUED AS A NATTER 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 M an ADDITIONAL INSURED,the polle"48)must be endorsed SU131WGATION IS WAIVED,iiRR to
the terms and conditions of the policy,certain policies may require an endomemenL A statement on Oft certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER
Aon Risk Services, Inc of Florida : OW2Hs;_7122 800-363-0105
1001 Brickell Bay Drive
suite 1100
Miami FL 33131 USA
DISI ERM AFFORDRIG C01MRAGE NAIL•
01SURED MISRiERA: The insurance Co of the State of PA 19429
DHL- Arellano construction Company emUMIRe:
7051 S.W. 12th street
Ni ami FL 33144 USA 94SURER O:
DffiIRERO:
CIE:
INSURER F: - -
COVERAGES CERTIFICATE NUMBER:570054742801 REVISION.NUMBER:
THIS 15 TOC THAT POLICE 1 CE BELOW HAVE[SEEN TO THE 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LbnIe shown are as requested
TYPE OF aSUeIANCE POLICY NIRMER MUM LOOTS
X COWX9 ft6E EIIALL=LFTY 6L EACH OCCURRENCE $2,000,
occuR PR�allar168 000MV100)
E300,000
MED EXP(Any one pwwr# $10,000
PERSONAL.AADV NJURY $2,000,000
GEN'LAGGREOATELWRAPPLMSPER: OENERALAI MUMTE
POLICY �X . x❑tOC ECT PRODUCTS•COMPIOPAOG - $4,000,000 ~
OTHER:
alrrowEwDBLJABRRY c0MSINEo sp10LE LOBr G;
ANYAUTO
BODL.Y KLRY(Per pawn)
ALL,OWNEDSCHEDULED SOORY INAM(Peraagd" lq
AUTOS AUTOS PROPOMDAIMSE
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AUTO/
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OCCUR EACHOCCURRENCE
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ICGM22293
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOYE Dry POS BE CANCELED BEFORE WE
OWMI TION DATE THEREOF,NOTICE Wal BE DEUVERED IN ACCORDANCE 110TH THE
POLICYPRWIS1011e.
Miami shores village Bldg Dept AUTHORMEDRID SSENTATIVE
1005 NE 2nd Ave.
Miami Shores, FL 33138 USA
0181E-2014 ACORD CORPORATION.All rights reserved.
ACORD 26(2014101), The ACORD new and logo are registered marks of ACORD
't
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f'
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ACC>RC7® CERTIFICATE OF LIABILITY INSURANCE �7/28
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT1AFFIRMIATIVELY 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: It the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subjecbto
the terms and conditions of the policy,certain policies may require an endorsement. A stat@rmad on this cardflcate does not confer r10 is to the
cerHflcate homer In lieu of such andoreeme s.
PRODUM Or,IT
Seitlin, A MarshaNcLennan Agenay LLC Cc PHONE RAX
1000 Corporate Drive (9543 938-8788 Ne:(9543 938-8566
Suite 400 USES:
Ft. Lauderdale FL 33334
AFFORODIe COYEILAeE NNC 9
WSURER A;Bridgefield layers ins. Co. 10701
INSURED 091URER B:
OHL-Arellano Construction Company
tNS11RkR C
7051 SK 12 Street INSURERD:
Miami FL 33144 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:Cert ID 43743 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVEFORTHE 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.
am DL SUGH POLICYIff-
TYPE OF 01KffL NCE POLICY NUMSER umm;
GENERAL LIABILITY EACHOCCURRENCE $
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE 0 OCCUR MED EXP are $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GENT.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $
POLICY PRO LOC GLEI $
AUTOMOBILE L IASUM
ANY AUTO BODILY INJURY(Per PW=) $
AL ALL
O ED SCHEDULED BODILY INJURY(Per aoddeM) $
AUTOS
NON-OWNED PROPFJZTY $
HIRED AUTOS AUTOS $
UMBRELLA
HCLAIMS-MADE
OCCUR EACH)CCURRENCE 8
AGGREGATE $
R 1 1 $
A YIN 830-50035 1/20/2014 1/20/2015 -$
OTH
WC ST -
==WE=W )fCWDED? 1 N/A E.L.EACH ACCIDENT $ 1.000.000
E.LDISEASE-EAEMPLOYEE $ 1,000,000
B de ON Z OPERATIONS balsa El.DISEASE-POLICY LIMIT $ 11000 000
DBSOfWn=OF OPERATIONS I LOCATIONS I VEHICLES(A ASD 161.AdMonal Remarks Salmdub.B arse apace 18 as110211)
Rea CW1522283
Proof of Iaaurance only.
CERTIFICATE HOLDER CANCELLATION
p SIMLD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF.;NOTICE WILL BE DELIVERED Or
ACCORDANCE WITH THE POLICY PROVISIONS.
Miami Shores Village Bldg Dept
10050 RS tad Ave. A�tSPR®ENTATIVE
Miami Shores FL 33138
1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010MM The ACORD name and logo we reglstered madw of ACORD