DEMO-14-1464 (2) E ry
Miami Shores Village
� 6 g JUL 204
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
FBC 20 [L>
BUILDING Master Permit No run(
PERMIT APPLICATION Sub Permit No.
) B UILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING MECHANICAL ❑PUBLIC ORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 11300 NE 2 Ave PAC qaf
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 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 2 Ave
City: Miami Shores State: Florida Zip: 33161
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR:Company Name: JWR Construction Services, Inc. Phone#: 954-480-2800
Address: 1311 W Newport Center Dr. Suite C
City: Deerfield Beach State: Florida Zip: 33'4442
Qualifier Name: Jerry DuBois Phone#: 954-480-2800
State Certification or Registration#: CGCO34031 Certificate of Competency#: 180-2092
DESIGNER:Architect/Engineer: Gallo Herbert Architects Phone#: 954-974-0300
Address:1311 W Newport Center Dr. Suite A city:-Deerfield Beach state: FL Zip: 33442
Value of Work for this Permit:$ zkAJOSG.cu Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace Q Demolition
Description of Work: Demolition _ i3 Lt C.lc S-To P
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)
jorddn's Permit ••• ,�• Construction
P Jorddn R. Morgan
gU11At `-- President
www.jpem.net
954-789-9363
-� • � Jordan@jpecs•net
We StanJ6 Lw So You Dadt HamTo
• t
Bonding Company's Name(if applicable) N/A
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable) N/A
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 such posted 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 foregoi g In ument was acknowledged before me this
day of S � ,20 Ig ,by day2ki:e_ by
SogN 1Q�AV .. is personally knower l ,__who is personally known to
me 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: NOTARY PUBLIC:
VJSign Sign: C)�-' oft
P ' Print-
MY
iriH coUNSstoN#EE36829 Seal:
'• J L HOWARD
EXpMM.Navambw 1z,2oia ,/• •: MY COMMISSION it EE878792
rnar � �• EXFIRES June 06.201?
t t!ss
************************************************************************ ***********
APPROVED BY , Plans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
a �
ACODREY CERTIFICATE OF LIABILITY INSURANCE
7/1/2014
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(SL 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 terns 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).
PROWLER CONTACT
NAME.
Bateman Gordon and Sands PHONE FA7C Ne -
2006
3050 North Federal Hwy E4KAL
Lighthouse Point FL 33064 Ad5gbwoaaIQbgMency.corn
INSU AFFORDING COVERAGE MAICN
INSURERA;Amerisure Insurance Co. 19488
INSURED JWRCO INSURER s;Amerisure Mutual Insurance Co. 23396
JWR Construction Services, Inc. INsuRERc-Westchester
1311 W Newport Center Drive,Ste C INSURERD:
Deerfield Beach FL 33442
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:1218815615 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.
ADM SUBR
TR TYPE OF INSURANCEPOLICY NUMBER POLICY EFF POLICY EXP
LLam
A GENERAL LIABILITY OL20089551401 17/2014 17/2015 EACH OCCURRENCE $1,000,000
DAMAGE X COMMERCIAL GENERAL LIABILITY PREMI ET RE $100,000
CLAIMS-MADE Ik–I OCCUR MED EXP(Arty one person) $5,000
PERSONAL&ADV INJURY $1,000 000
GENERAL AGGREGATE $2,000,000
GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,0W
1-1 PRO
POLICY KI LOC I $
A AUTOMOBILE LIABILITY CA13885011201 17/2014 17/2015 -AED $1100010W
X ANY AUTO BODILY INJURY(Per persar) $
ALL OWNED SCHEDULED BODILY INJURY(Per acddent) $
AUTOS AUTOS
NON—OWNED PROPERTY DAMAGE
X HIRED AUTOS Ix
AUTOS Per $
B UMBRELLA LIAR X OCCUR CU13SOM1202 17/2014 17/2015 EACH OCCURRENCE $5,00,000
EXCESS Lab CLAIMS-MADE AGGREGATE $51000,000
DED X RETENTION$0 $
WORKERS COMPENSATION VC13292881502 11112014 /1/2015 XWCSTATU OTH
AND EMPLOYERS'LIABILITY Y I N
ANY PROPRIETOR/PARTNEWEXECUTIVEF-1 NIA E.L.EACH ACCIDENT $1,000,000
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH) EL DISEASE-EA EMPLOYEE $1,000,000
yea.If
d10 OF
DESCROPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000
A Rented&Leased Equipment CPPI386=1201 311712014 17/2015 Limit$100,000 Deductible$1,000
C Pollution Liability G77462376001 N412014 31412015 LImit$1,000,000 Deductible $10,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEMLES(Attach ACORD 101,Additional Remarks Sdradule.If nrore spm M reWdred)
JWR Construction is General Contractor CG#CGCO34031
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 2ND AVE
MIAMI SHORES, FL 33138 t,TMWJZEo REPRESENTAWE
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