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ELC-16-98210050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 Project Address 9050 BISCAYNE Boulevard Miami Shores, FL 33138 - Owner Information PUBLIX SUPERMARKETS, INC Permit NO. ELC-4-16-982 Permit Type: Electrical - Commercial Work Classification: Addition/Alteration Permit Status: APPROVED Issue Date: 4/25/2016 Expires: 10/22/2016 Parcel No.. 1132060100010 Address Tract No. P 0 BOX 407 LAKELAND FL 33802-0407 Block No. Lot No. Section Township Phone (863)688-747_ Cell Contractor(s) Phone Primary Contractor ATTAWAY ELECTRIC INC (954)791-3373 Yes Proposed Construction / Details ELECTRICAL WORK FOR INTERIOR REMODEL To EXISTING PUBLIX. Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $30.60 $22.95 $22.95 $10.20 $1,530.00 $3.00 $40.80 $1,660.50 Valuation: Total Sq Feet: $ 51,000.00 0 Total I Amt Paid I Amt Due $ 3,190.50 $ 1,660.50 $ 1,530.00 Required Inspections: For Inspections call 1(866) 701-3365 Inspection IVR See Permit Record Building Department Copy Monday, ril 25, 2016 2 BUILDING PERMIT APPLICATION Miami Shores Village 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 (-ALL FBC 201(4 Master Permit No. 1 - /A2 - [S' 3D502 Sub Permit No. ?�t.�Q.-) ( -992, BUILDING ❑■ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING MECHANICAL El PUBLIC WORKS ❑ CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9050 Biscayne Blvd. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-32067010-0010 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): Nrthem Trust Bank ETAL % Publix Super Market phone#: 863-688-1188 Address: Post Office Box 32025 City: LakelandState: FL Zip: 33802 Tenant/Lessee Name: Publix Super Markets Location #0794 Email: Phone#: CONTRACTOR: Compan Name: Address 3 l Y If S �O City: I� Qualifier Name: Jacky IQck_ IhC Phonett - 11, -S)3 State: Zip: 333 I L1 Phone#:�q1 ��13 State Certification or Registration #: EC 13 b ab 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 Q Repair/Replace ❑ Demolition Description of Work: 91 CT lc4 % (A) 0 4)., vi -N- - -stt 2A ez)5/,4 Diff"L -i eXi5-nocc PU©L4x Specify color of color:thru tile: Submittal Fee $ 50 ' ( Permit Fee $ ! 3l> 1045 CCF $ JL! • GO CO/CC $ 0 Scanning Fee $ 3t•t /�� Q Radon Fee $ !22 I DBPR,$22q5 Notary $ Technology Fee $ �I V . C1 O Training/Education Fee $ I Q'w Double Fee $ Structural Reviews $ Bond $ (Revised02/24/2014) TOTAL FEE NOW DUE $ I, 610.5D 1 . k Bonding Company's Name (if applicable) lky 4 - Bonding Company's Address I f 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: 1 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 The forgoing instrument was acknowledged before me this The foregoing inst�� day of Dec>°Imbei-- , 20 15 , by 14, v day of 'il ee✓'j-i" who is personally known to -ioa 4( IL4 Q me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sig Print: LSIceit, Sea l:°`p0.�°°��� JODIL.SLOAN * (_ * MY COMMISSION # FF 184644 EXPIRES: February 5, 2019 "rFOF F03e`OT Bonded Thru Budget Notary Services t was acknowledged before me this , wh personally known by as me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: wa fir k }t=, Waecb- .071i ARLETTA WOOD .+= MY COMMISSION # FF 001997 •-�� res EXPIRES: May 27, 2017 $"fl•, Bonded Thru Notary Public UAderwrgera ********************************************************************************** APPROVED BY . Plans Examiner ** ************ Zoning Structural Review Clerk (Revised02/24/2014) • 4.4 s. ..,� ks. fT' BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 — 954-831-4000 VALID OCTOBER 1, 2015 THROUGH SEPTEMBER 30, 2016 DBA: Business Name; ATTAWAY ELECTRIC INC Receipt #:ELECTRICAL/ALARMSICONTRACTO�� Business Type; r Owner Name: JACK HINDE Business Opened:02/10/2016 Business Location: 3350 BURRIS ROAD State/County/Cert/Reg:EC13004005 DAVIE Exemption Code: Business Phone: 954-791-3373 Rooms Seats Employees 10 Machines Professionals For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED Mailing Address: ATTAWAY ELECTRIC INC 3350 BURRIS ROAD DAVIE, FL 33314 This tax is levied for the privilege of doing business within Broward County and is non -regulatory in nature. You must meet all County and/or Municipality planning and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. 2015 - 2016 Receipt #03C-15-00000091 Paid 02/10/2016 27.00 3. • ' STATE QFFDORIDA .- DEPARTMENT OF BUSIIN SS;,;AND.PJ OFES$IONALREGULATIQN.. EL-EOTRICAL c- FAe RLIS,- ENSiNGpOARD-'-: LICENSE NUMBER .' ,. _... _ 'x� .�_ Y- '•• , �a ... �,. r�r �. l9 + 0l)5 W ... + ,..,,...,,..............,,,,--*---.....,:.,,,,,-.......—..• a �- -.Y . '...+ .. -.4'7.:44''''''''''''''''''. . L _. ...i ,ti `r, ." -- "--t`` .n, u. ` ' �'' 4, . t. M1 `..%." a `� ` S' •Zi d'e" IowriStk E • , dr'fFlej o ii'ix ,,ca. apter fide--M-r-LO ISSUED: 08/09/2014 DISPLAY AS REQUIRED BY LAW SEO # L1406090001177 ATTAW-5 OP ID: D3 ACORU" CERTIFICATE OF LIABILITY INSURANCE 41....'----- DATE(MMIDD/YYYY) 04/05/2016 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 pollcy(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 Brown & Brown of Florida, Inc. 1201 W Cypress Creek Rd # 130 P.O. Box 5727 0 Ft. Lauderdale, FL 33310-5727 Ken E Willits, CPCU, CFP, CRIS CONTACT P ONE FAX (AIC. No. Ext):954-776-2222 (ac, No): 954-776-4446 Ea11A0. ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURER A: Amerisure Insurance Company 19488 INSURED Attaway Electric, Inc. 3350 Burris Road, Suite B Fort Lauderdale, FL 33314 INSURER a : Amerisure Mutual Ins. Co. 23396 INSURER c: 01/01/2017 INSURER D : $ 1,000,000 INSURER E : INSURER F: X 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MMIDD/YYYY) POLICY EXP (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY GL205096308 01/01/2016 01/01/2017 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR AMAGE TO RENTEDaoccurtence) PREDMISES (E $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GE 'L AGGREGATE POLICY OTHER: X LIMIT APPLIES mi. PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 Emp Ben. $ 1,000,000 A AUTOMOBILE X XX LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS _AUTOS SCHEDULED AUTOS NON -OWNED CA205096208 01/01/2016 01/01/2017 COMBINED SINGLE LIMIT (Ea accident) $ 1 000 000 > > BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE CU207140606 01/01/2016 01/01/2017 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED X RETENT ON $ 0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABLITY YN AFYIPEXARTN D PROPRIETOR7 ECUTIVE (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N N / A WC205095708 01/01/2016 01/01/2017 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Contractor License# EC 13004005. CERTIFICATE HOLDER CANCELLATION I MIAMISH Miami Shores Village Building Department 10050 NW 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2014/01) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD