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MC-16-1842 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 C,C Inspection Number: INSP-262385 PermitNumber: MC-7-16-1842 Scheduled Inspection Date: August 24,2016 Permit Type: Mechanical - Commercial Inspector: Perez,JanPierre Inspection Type: Final Owner: , BARRY UNIVERSITY Work Classification: Addition/Alteration Job Address:11300 NE 2 Avenue Adrian Hall Miami Shores, FL 33138-0000 Phone Number Parcel Number 1121360010160-07 Project: BARRY UNIVERSITY Contractor: TRIUMPH AC&REFRIGERATION CORP Phone: (786)512-0548 Building Department Comments DUCTWORK&GRILLS Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 23,2016 For Inspections please call: (305)762-4949 Page 8 of 34 ° oy Miami Shores Villages Tyt 10050 N.E.2nd Avenue NE = It1�C}ttc C18ssi# a� Miami Shores,FL 33138-0000 hyo Phone: (305)795-2204 1/8120 Expiration: 1104/2017 Project Address Parcel Number Applicant 11300 NE 2 Avenue Number: Adrian Hall 1121360010160-07 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: $ 2,400.00 TRIUMPH AC&REFRIGERATION COF (786)512-0548 Total Sq Feet: 0 Tons:0 Available Inspections: Additional Info:DUCTWORK&GRILLS Inspection Type: Classification:Commercial Ventilation Approved:In Review Final Comments: Date Approved::In Review Rough Date Denied: Type of Work: Rough Duct Scanning:1 Duct Detector Test Review Mechanical Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# MC-7-16-60426 DBPR Fee $2.25 07/01/2016 Credit Card $50.00 $112.30 DCA Fee $2.25 Education Surcharge $0.60 07/08/2016 Credit Card $ 112.30 $0.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $162.30 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-namd�entr ctor to do the work stated. i July 08,2016 Authorized Signature:Owner / Applicant 0 ,6ntra&for / Agent Date Building Department Copy July 08,2016 1 �M Miami Shores Village Building Department JUL 04 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 BUILDING Master Permit No.C-C-5-A:�-A� / PERMIT APPLICATION Sub Permit No. 14(— -1(0 ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING -PMECHANICAL [—]PUBLICWORKS [jCHANGE OF E]CANCELLATION ❑ SHOP �p CONTRACTOR /�/// DRAWINGS JOB ADDRESS: /,/&6!J 1pe-- 14,06e,/fit/ /,f City: Miami Shores County: Miami Dade _Zip: lo Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): )�"q 416,w k2" ��/ -T-111C Phone#:3 3 7---PU Address: // 3 49 0 - City: 1-111114A-Vr State: 1 Zip: 3! 6 �_ Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Phone#: 766 Address: /0 City: a state: Zip: _5 3c-1(� Qualifier Name: vc -L Phone#: 1� State Certification or Registration#: a4e—l- (0 2'29 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ° Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: -byo x 1t- 4 4? ,f Specify color of color thru tile: Submittal Fee$ Q�) Permit Fee$ 00 CCF$ ® CO/CC$ Scanning Fee$ 7�3 - CK) Radon Fee$ DBPR$ Notary$ Technology Fee$ f Training/Education Fee$ Q ® Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ l/ (2 , 30 J,_ ke 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 commen ement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issue In t e absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature Signature— OWNER or AGENT C CTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this —day of....��y�� 20 '`P by day of U 20 by ��y 'W�b>rl ►L who is personally known to �"� �� I �®;w�hyoo is personally known to me or who has produced as me i��T,�L�or who has produced A - as identification and who did take an oath. identification and who did take an oath. NOTARY P LIC: NOTARY PUBLIC: MY CON9YlISS 95t>915 _ EXPIRES:February 9,202D Sign: Sign: Bonded ft Notary Pulft Undembrs Print: V Print: L% NftqSeal: f JY� aFtorwe Seal: My CommbsW FF 188481 Expires Explre611H2/201e APPROVED BY ans Examiner Zoning Structural Review Clerk ACZWOCERTIFICATE OF LIABILITY INSURANCE °A�07 /01/i6' 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: ff the certificate holder Is an ADDITIONAL INSURED,the policypes)must be endorsed. If SUBROGATION IS WANED,subject to the tette 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). PRODUCERTCT NAMFirst General Insurance PHONE (305)817-03031 FA ; (305)817-0333 7900 NW 155 St,Suite 102 AWL cbnizon@firstgeneralinsurance.com Miami Lakes,FL 33016 INSURERS)AFFORDING COVERAGE NAIC 0 Phone (305)817-0303 Fax (305)817-0333 INSURER A: AMTRt1ST NORTH AMERICA INSURED INSURER 0: ASCENDANT TRIUMPH AC&REFRIGERATION CORP INSURER C: PROGRESSIVE 8821 N W 112 TERRACE INSURER D: HIALEAH GARDENS,FL 33018 305 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. 1 TSR TYPE OF INSURANCE ADD POLICY NUMBER hP EFF MMM DD EXP YYYJ LIMAS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 © ETO COMMERCIAL GENERAL LIABILITY PREMG ES EaENTED o $ 100,000.00 B ❑ ❑ CLAIMS-MADE 0 OCCUR N GL-45822-1 10/24/2015 10/24/2016 MED EXP(Any oneperson) $ 5,000.00 ❑ PERSONAL 8 ADV INJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE S 2,000,000.00 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 1,000,000.00 ❑ POLICY ❑ PRO- ❑ LOC $ AUTOMOBILE LIABILITYED SINGLE LIMIT M100,000 dera ❑ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 08429345-3 BODILY INJURY(per accident $ C ❑ AUTOS © AUTOS N 02/032016 02/03/2017 PROPERTY DAMAGE NON-OWNED $ ❑ HIRED AUTOS ❑ AUTOS Per actldarht ❑ ❑ PERSONAL INJURY $ 10,000.00 ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION ®wC sTATW RJ0TH- NONE AND EMPLOYERS!LIABILITY YIN ANY PROPRIETORWARTNERIMCUTIVE AWC1064057 E.L.EACH ACCIDENT $ 500,000.00 A OFFICERIMEMSER EXCLUDED? NIA 05/012016 05/012017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ 500,000.00 K yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000.00 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more apace is required) A/C REPAIR&INSTALLATION CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2 AVENUE AUTHORIZED REPRE,REWATIVE MIAMI SHORES,FL 33138 ROSIE BRUZON ACORD 25(2010/05)QF The ACORD name ame and 0 ACORD CORPORATION.registered . All rights reserved. logo registered marks of ACORD