DEMO-14-1517 17) -a ran H - �464
Inspection Worksheet
Miami Shores Village
10050 N.E.2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-215938 Permit Number: DEMO-7-14-1517
Scheduled Inspection Date: September 19,2014 Permit Type: Demolition
Inspector. Devaney,Michael
Inspection Type: Final
Owner: , BARRY UNIVERSITY Work Classification: Electric
Job Address:11300 NE 2 Avenue Thompson Hall
Miami Shores, FL 33138-0000 Phone Number
Parcel Number 1121360010160-02
Project: BARRY UNIVERSITY
Contractor: C DAVIS ELECTRIC COMPANY, INC Phone: (954)432.4334
Building Department Comments
ELECTRICAL DEMOLITION BUCK STOP Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed 21
S�
Failed
Correction �' 1-7I-Al
Needed
Re-Inspection
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
September 18,2014 For Inspections please call: (305)762.4949 Page 7 of 31
Miami Shores VillageLxPlIt-Fl�—C�����b Z 14
Building Department
10050 N.E.2nd Avenue,Miami Shores,Florida 33138 —
Tel:(305)795-2204 Fax:(305)756-8972
INSPECTION UNE PHONE NUMBER:(305)762-4949
FBC 20i4,,
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BUILDING Master Permit No �2 7_ 6
PERMIT APPLICATION Sub Permit No.-F,L,I LA -=- 1's 1'4--
❑BUILDING ELECTRIC ❑ ROOFING REVISION EXTENSION RENEWAL
[]PLUMBING ❑MECHANICAL F]PUBLIC WORKS ❑CHANGE OF [] CANCELLATION ❑SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 11300 NE 2 Ave
40W entami,st+ Ctv+c+tu• Affiami ade
Folio/Parcei#• 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 NW 2 Ave
Miami Shoresstate: Florida 1.133161
Tenant/Lessee Namd Phone#:
Email-
CONTRACTOR:Company Name C Davis Electric 'Pho ne#: 954432-4334
Address: 1701 SW 100 Terrace
city: Miramar :state. Florida zip: 33025
Qualifier Name: Ed_Davis ,Phe ne#: 954-432-4334
State Certification or Registration#. E00001038 Certificate of Competency#:
DESIGNER:Architect/Engineer:.Gallo Herbert Architects :Phd ne#: 954-794-0300
Address,1311 W Newport Center Dr. Suite C_ City: Deerfield Beach state: FL zip: 33442
Value of Work for this Permit: 17t�e r Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑• New ❑ Repair/Replace Q Demolition
Description of work Demolition Buck Mop
Specify color of color thru tilez
Submittal Fee,��v` 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$
(ReWsed02/24/2014)
Bonding Company's Name(if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name(if applicable)
Mortgage Lender's Address
qty 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 folth 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 certried copy of the recorded notice of commencement must be pasted 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.
Sigriaiate
OWNER or AGENT CONTRACTOR
The
Jotforeggo,ing Instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
oda of /44 20 by 11th day of JUlY 20 14 ,by
. kit A 5 who is personally known to_ Ed Davis ,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:
Sign: &-- • A � Sign:
Print t Od Print: BENNETT
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`�,11tNiNi1!//j�� Commission#EE 217497
Seal: `\`���gp,RA iq� Seal: . a Expires September 25,2015
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APPROVED BlPlans Examiner Zoning
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Structural Review Clerk
(Revtsed02i24(2014)
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CERTIFICATE OF LIABILITY INSURANCE1 3125=14
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TNIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES HOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y 11*POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORtANTi if the Certificate hoiden Is an ADDITIONAL INSURED,the pofiey(fas)must be endorse. If SUBROGATION IS WAIVED,aubjaat to
the terow 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 Tlsu of such endor88me0e
PRODUCER NA Lori S. Gleason _
2233 Eg�M,A ter,She Lambert LLC s (661)776.9001 0. 867 427.6730
suite lox „�,Igleason calga.aoat
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INeoRED Ips -,AmvrIsUM Mutual ins Cc 23396
C.Davis Electric Company,Inc. imamme:BrIdgefiald Casual Ins Co 10336
1701 Southwest 100th terrace INS mit o:T'ravelers Casualty Ins Cc of America
Pgrarlar,FL 33026 NSURnI E
INMER a,
COVERAGES CERTIFICATE NUMBER! REVIOION NUMBER:
THiS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDiCATIA. NOTWITHSTANDING ANY REQUiREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO MICH THIS
CHR71FICATE MAY BE ISSUED ON MAY PERTAIN. THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED MEREINISSUBdECTTOALL THE TERMS,
EXCWSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED 13Y PAID CLAIMS.
YrPE OF 1NeURANG6 �FWU6 WKS
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GENERAL LIASOJW Encre«;cuRR®ucE 8 1,000,E
A X eeuMSRCIA VENERAL LIABLITY OPP20UN3800000 4112014 41112015 FRIANIS 100,00
CLAIMS-MADE FRI OGCVR MED DIP(Anp one pemni 1 8,00
X XCU&Contractual PEASOWL&acv WJuRY s 11000100
X Broad Form Prop Dam 09NERALAGGREGATE s 200,
LrWLAGGREM'TELIMIT APPLIES PEW PRODUCTS-COMpiop0 2,000190
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AUTOMOBILELWBIUIY a OIN UGI BLBLINff 1,000,00
A JX ANYAUTO 0877670401 41112014 4N112D16 BODILYMJURY(Perpereee) 1A Q_VIIn SCHEDULED
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X uNaRF1LALUrB X ---- R PIP Coverage s 10.00(
EACM OCCURRENCe 6,0001
B OMEN LIAS CLAIMS-LADE CU20b77540402 41112014 4111=6 ACO MMT11 a 6,000,
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D ctleduled Equipment 0600866C't62T1L13 4112014 411P�M5 Special,52,600 Ded.
f OHOPOP9PAMONSILOGATMNIVEHICUS(AlhuhACORD iQt,AdmendRwnm4w fthwIxh4Ngum epLaehrequb"
Certificate holder Is named Is additional Insured Inetoding products end completed opera6one for general liability per CG7048,auto(iabliny,and ualbretla
Ilablllry when required by wri"m contract,General Liabll(ty.Auto Llablllly,and Umbrella see primary and nary contrlbutDry when required by wrltten e0ntreat.
r of subrogation applies to general 6ablllty par CG7044.auto liability per CA7171,umbrella IlablOty,and workers'compensatfoo when requlmd by
Alton contract Umbrella extends overgeneral Ilablitty,euro Ilabtlity and empioyers liability.Me residential construction exclusion(non 190 ormanuscdpU
policy forme that exclude residential eonatnuctlon)[a atlaohed to the poilulm The poRalae an subject to Standard MO Terris end Condlilorur.Canceliation
per policy tans and conmone.
Commercial Electrical Contractor
CERTIFICATE H01,13911 CANCELLATION
SHOULD ANY OP THE ABOVE{nWRraw PM==BE G"CELLED BEFORE
Mand Shores Village,City of THE: EXPIRATION DATE THEREOP, NOME VE-L BE DELIVERED IN
Building Deparbrlent ACCORDANCE WrrH no FoLIay PROVIS(ON9.
10000 NE 2nd Avenue
MEand Shores,FL 33138 AUTHORMP REPREIMITATTVB
01OW2040 ACORD coupe Anox Ag rights reserved.
ACORD 25(2010/05) The ACORD naMe aid logo dee registered marks of ACOR[i
115S.Andrews Ave., Rm. A 100, Ft. Lauderdale., 51L 33301-1895-954--831-4000 i
VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2414ype �
Recelpt#:181=81379
o Busl'neas Name:C DAVIS ELECTRIC COMPANY xNC 8usir�ess.� :ELECTRxc�a'IMJ�s/Ca aR
Lc, (ELECTRICAL COMRACTOR)I
C; .
z
Owner Name:CH RLES •E DAVI8 JR Business Opened:o7/16/1993
Business Locatlon:1701 SW 100 TERR State/County/CertlReg:Ecoonio3•a
MIRAMAR Exemption Code:
Business Phone:432-4334
Rooms 'Seats=• EMpfgeas INachlnes ProfessEanals
For Vending Hifthlesa On!y. I
Number of Machines' Vending lyjp®:
' Tax Amount Traursfer Fee NSF Fee Penalty Prior Years Colle...ction Cost Total Palo
27:00 0.0 - ';V _ — :- �. .
� 0 0.00 27,00
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT This tax is levied for the priaitega of doing business within Browani County anijE•is s
non-regulatory in naturae.You must meet al!County and/or MnNcipallily planning
WHEN VALIDATED and zoning requirements. This Business Talc 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
!1 is in compliance with State or local laws and reguktioiis.
I Nailing Address: 3
a CHARLSS E DAVIS JR
1701 SK 100 TERR Receipt #032-12-00004848 =
m Paid b9/16/2013 27.00
�' NZRAMAR, FL 33.025
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