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CC-15-1974 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-253440 Permit Number: CC-8-15-1974 Scheduled Inspection Date: February 29,2016 Permit Type: Commercial Construction Inspector: Rodriguez,Jorge Inspection Type: Final Owner: , BARRY UNIVERSITY Work Classification: Repair Job Address: 11300 NE 2 Avenue Thompson Hall Miami Shores, FL 33138-0000 Phone Number Parcel Number 1121360010160-02 Project: BARRY UNIVERSITY Contractor: JWA,JW ANTHONY CONSTRUCTION INC Phone: (954)931-5447 Building Department Comments REPLACE COOLING TOWER, INSTALL NEW STEEL Infractio Passed comments TOWER SUPPORT AND SCREEN WALL,WITH HAND INSPECTOR COMMENTS False RAILS Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-240774. No permit/ladder 13111 Failed - Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid February 26,2016 For Inspections please call: (305)762-4949 Page 35 of 60 Sys hs�, Miami Shores Village P8i"T!?I 10050 N.E.2nd Avenue NE PP Miami Shores,FL 33138-0000 € Phone: (305)795-2204 lex A�t}1 Expiration: 02/20/2016 Project Address Parcel Number Applicant 11300 NE 2 Avenue Number: Thompson Hall 1121360010160-02 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: $ 108,206.00 JWA,JW ANTHONY CONSTRUCTION (954)931-5447 Total Sq Feet: 1040 Approved:In Review Available Inspections: Comments: Inspection Type: Date Approved::In Review Final Date Denied: Review Building Type of Construction:REPLACE COOLING TOWER,INST Occupancy Load: Stories: Exterior: Front Setback: Rear Setback: Left Setback: Right Setback: Plans Submitted:Yes Certification Status: Certification Date: Additional Info: Bond Retum: Classification:Commercial Scannin :3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $65.40 DBPR Fee InVOiCe# CC-8-15-56610 $48.68 08/24/2015 Check#:27679 $3,476.96 $50.00 DCA Fee $48.69 Education Surcharge $21.80 08/06/2015 Check#:27441 $50.00 $0.00 Permit Fee $3,246.18 Scanning Fee $9.00 Technology Fee $87.20 Total: $3,526.96 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 informatio ' accurate that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above e o the work stated. August 24, 2015 Authorized Signature:Owner / Applicant / Agent Date Building Department Copy August 24,2015 1 ' Miami Shores Village '7A �'°�°rv� Building Department j AUG n9 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 �,_ / \� Tel:(305)795-2204 Fax:(305)756-8972 --_-_ INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 IL-! -�h BUILDING Master Permit No r,Is o:1 PERMIT APPLICATION sub Permit No. ao'- R- 16- 219 5- UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 00 261 AV IE - 7040tAP5 N BALL. City: Miami Shores County: Miami Dade Zip -45-;1 � Folio/Parcel#: 11213 0o l t[00 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): I VJJK5in Phone#: 3 U r� ��f�7 � %';X)J Address: ?OLD 2 /l, VC City: �j I HO State: �=1_ Zip: _ ?D1 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: JWA� AW AALLAQAL� CO3 511007W..Ilk Phone#:9�W93)-59LQ Address: PP 0- f5®rC 22,4'1Ls City: ET LAUN State: F'L. Zip: 33335 Qualifier Name: AAI /SAY;1 4L7-b FS€L 1 Phone#: State Certification or Registration#:__e 6C-A 2-41• ?) Certificate of Competency#: DESIGNER:Architect/Engineer: Z�� L�'7Uf!s//���-11i/e� Phone#: 0 .�( -i6 53 Address: -1171S-7 BLUE L 004 b K. '5uaF-*M City: M/kw11 State: FL Zip:_3312-6, Value of Work for this Permit:$_ /D$12Q(0, oo Square/Linear-FF000tage of Work: 1.O� Sd{. Type of Work: El Addition El Alteration El New LR Repair/Replace ❑ Demolition Description of Work: &PLACE CMuN& MWER, I11571 tL AIEW 5T):�L ToWt-9 5j PPOR-T Specify color of color thru tile: Submittal Fee$ 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) 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 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 wi 1 be charged. Signature Signatur OWNERorAGENT C TRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this L day of -s7�19e 20 ,by day of J %3 ;20 V Sa by ✓ 11? ,who is personally known to 6nTr%6" M-k-Obc-N k,who is personally known to me or who has produced as me or who has producedas identification and who did take an oath. identification and who did take an oath. $ N \���t\1llllilll/p/�� NOTARY PUBLIC: aa �(�IS TA?D;;V ii/ NOTARY PUBLIC: m �.ee �',�1SSIOiyF•.• �� H H m � 28 Sign: S — Sign: Print: lFF Print: r .. �Q` ov Seal: !9 .► f O�� Seal: p`��� ,�arny�,'� LORI C.SMITH STAi� aNl11NINtt1�� Notary PuNc,=State of Florida N Q=my Comm.Exoies Jan 24,2017 >` a_ *********************ss ****** *** * ******************* *9i,.rua� .• **"OtIMrlltbS9>Dlil $�#f#tb�* * * �p�'•' ��euua� q�bniN�0�� f4*a APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised 02/24/2014) STATE OF FLORIDA s DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 VMS NORTH MONROE STREET TALLAHASSEE FL 32399-0783 ALTOBELL,ANTHONY JWA, JWANTHONY CONSTRUCTION, INC. P O BOX 22476 FORT LAUDERDALE FL 33335 Congratulations! With this license you become one of the nearly one mlI lon Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers,from boxers to barbeque restaurants, DEPARTMENT OF BUSINESS AND- and they keep Florida's economy strong. " PROFESSIQNAt:REGULATION Every day we work to improve the way we do business in order to CGCA24733 48UM 02/23/2015 serve you better. For information about our services,please log onto www.myfloridalicerme.com. There you can find more information CERTIFIED GEi�EFkAL CONTRACTOR about our divisions and the regulations that impact you,subscribe ALTOBELL,A!! N V to department newsletters and learn more about the Department's JWA,JW ANTHONY CONS7 'ttJTION,INC. 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, IS CERTIFIED under the provisions of Ch.489 FS. and congratulations on your new license! Expha iw dabs'AUG 31,2o16 L150223ODDIS36 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION r ^CONSTRUCTION,INDUSTRY LICENSING BOARD rCGGA24733 _ The GENERAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31,2016 ALTOBELL,ANTHONY ` JWA,JW ANTHONY COIF 408 S ANDREWS A(rizz-S .. .r, - . FORT LAUDERDALE"' ' 33301 �r, ♦■ 3 ■ -------- n•1H917A�C. rliCpl oY AR RFr]i npr-n RY I AW SEO# L1502230001538 Jul 2715 10:30a Altobell 9549995025 p.1 12 BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 1 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 DBA: ReCelpt :GENERAL CONTRACTOR Business Name: 68937 JWA JW ANTHONY CONSTRUCTION INC Business Type: Owner Name:ANTHONY ALTOBELL Business Opened:o5/05/2015 Business Location: 6851 SW 8 ST StatelCounty/Cert/Reg:CGCA24733 PLANTATION Exemption Code: Business Phone:954-931-5447 Rooms Seats Employees Machines Professionals 1 For Vending Business Only Plumber of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.G0 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature. You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: JWA JW ANTHONY CONSTRUCTION INC Receipt #1CP-14-00012217 PO BOX 22476 Paid 07/10/2015 27.00 FORT LAUDERDALE, FL 33335 07/09/2015 Effective Date r r 215 - 216 ACCO CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD1YYYY) F6/25/2015 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 NAME: Bateman Gordon and Sands PHONEFAX 3050 North Federal Hwy EMAIL - -0900 a/C No: -941-2006 Lighthouse Point FL 33064 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: SpecialtyICRC INSURED JWANT INSURER S: JWA,JW Anthony Construction, Inc. INSURER C: P.O. BOX 22476 INSURER D: Fort Lauderdale FL 33335 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1829137535 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 ADDL UBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY) _JMM/DDfYYYYI LIMITS A GENERAL LIABILITY AGL001966700 11!20/2014 11/20/2015 EACH OCCURRENCE $1,000,000 DAMAGE'M RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occu encs $100,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 X POLICY PRO LOC Per Claim Deductible $2,500 AUTOMOBILE LIABILITY COMBINED SINGLE Un7T__ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( I NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEO RETENTION$ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ II DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) License#CGC A24733 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village-Bldg Dept ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2ne Ave Miami Shores FL 33138 AUTH RIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD JEFF ATWATER CHIEF FINA1ICIAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION CERTIFICATE OF ELECTION TO BE T FROM FLORIDA WORKERS'COWENSATION LAW '� CONSTRUCTION INDUSTRY EKEMPTION This cerfifles that the individual luted below has elected to be exempt from Florida Wofkt3T$'Compensation haw. EFFECTIVE DATE: 3/4/2015 EXPIRATION DATE: 3/3/2017 PERSON: ALT013R I ANTHONY FEIN: 550679189 BUSINESS NAME AND ADDRESS: JWA JW ANTHONY CONSTRUCTION INC P.O.BOX 22476 FORT LAUDERDALE FL 33335 SCOPES OF BUSINESS OR TRADE: UCENSED GENERAL UCENSED ROOFING CONTRACTOR CONTRACTOR PmRwd to Chaptar440M(14).F.S..an afticer of cmpmamt who elects exemption fmm yds dmpte by SM9 a t wWxato of ebcbn tta W Vda> acgon nmY not tacoverhetm$s or cmnpmmdbn tetderthis chapter.Pwsiantto Chapter440,05(12).F.S.,Ca tiftebm of elMtion to be exempt--apply mNY wodn the asps of the husiness ortrads ted on IIID no@ce of aiergm tabs exp Pursuant to ChaPter440MR13),F S-,N0ft"of etectiOn to be exempt end Cmticates ofebc tt to beawaptWo he athjeat to nonxWon h;at MYtirnaaWft tft of the rhe or the b8imme of the a the person named on the.. or CNMCMno Longer meats the rertukWMvds of4de section for rss,u M of a CefficakL The department shop raceka a corsnaate er DFS-F2-DWC-232 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850}413-1609 ����'lii�) 8� �������.��S�H������41 � }$��C'P,y�)FEF--��S�fyJ+ (E�i£F&iiE) ►►Yd.o$. SttOR sign Miami shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305)756.8972 Notice to Owner - Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers'Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers'compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if- 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers'compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: Owner j State of Florida County of Miami-Dade The foregoing was acknowledge before me thi day of 20 before is to me or has produced tax VI ruluan— lF asidentifiqXnN'-*, SS10N4F*. No IiII1111: ................ �w SEAL: Z #FF 220337 SZ5 JWA JW ANTHONY CONSTRUCTION INC. General Contractor/Roofing Contractor P.O.BOX 22476 FORT LAUDERDALE,FLORIDA 33335 954 931-5447 FAX 954 999-5025 July 20,2015 State of Florida County of Broward Before me this day personally appeare who,being duly sworn,deposes and says: IL That he will be the only person working on the project located at. Barry University Thompson Hall. Sworn to(or affirmed)and subscribed before me this day of 2015 by Personally known Or Produced Identification Type of Identification Produced Prin ype or Stamp Name tary JOANN SGAMMATO Notary Public-State of Florida • .c My Comm.Expires Nov 21,2018 ' Commission# FF 144767 ........... 1...;,