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ELC-18-577 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204. Fax: (305)756-8972 Inspection Number: INSP-300423 Permit Number: ELC-3-18-577 Scheduled Inspection Date: March 29,2018 Permit Type: Electrical - Commercial Inspector: Devaney, Michael Inspection Type. Owner: CHURCH, MIAMI SHORES BAPTIST Work Classification: Servicelthange Job Address:425 NE 95 Street f Miami Shores, FL Phone Number (305)758-0559 Parcel Number 1132060140610 Project: <NONE> Contractor: POTENTIAL DIFFERENCE INC. Building Department Comments REPLACE METER MAIN AND GROUND RODS Infractio Passed Comments INSPECTOR COMMENTS True F P L notified. Inspector Comments Passed F P L notified. ✓ Q l Failed C Correction Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. March 28,2018 For Inspections please call: (305)762-4949 Page 25 of 30 i Permit N©. ELC- -1$-577 `yeoREs Miami Shores Village Permit Type:Electrical-Commercialtea. q 10050 N.E.2nd Avenue NE 'Peri� ' ..�� 't Work Classification:Service Change .. Miami Shores,FL 33138-0000 Pennit Status:APPROVED ®IN' " Phone: (305)795-2204 �'N1F FtoRivA issue Date.312712018 Expiration: 09/23/2018 Project Address Parcel Number Applicant 425 NE 95 Street 1132060140610 MIAMI SHORES BAPTIST CH Miami Shores, FL Block: Lot: Owner information Address Phone Cell MIAMI SHORES BAPTIST CH 370 GRAND CONCOURSE AVE (305)758-0559 MIAMI FL 33138-2753 Contractor(s) Phone Cell Phone Valuation: $ 2,250:00 POTENTIAL DIFFERENCE INC. Total Sq Feet: 0 Type of Work:REPLACE METER MAIN AND GROUND RODS Available Inspections: Additional Info:REPLACE METER MAIN AND GROUND RODS Inspection Type: Classification:Commercial Review Electrical Scanning:2 Review Electrical i r Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# ELC-3-18-66692 DBPR Fee $2.25 03/27/2018 Credit Card $ 117.05 $ 50.00 DCA Fee $2.00 Education Surcharge $0.60 03/06/2018 Credit Card $50.00 $0.00 Notary Fee $5.00 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $2.40 Total: $167.05 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 conformit with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this pert I assume respon ibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECT ICAL,PLUMBING, MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFF IT: I certify that I the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction nd o ing. Futhermore I uthorize the above-named contractor to do the work stated. �. March 27, 2018 Auth ize Sign&e:drwner / App ca / Contractor / Agent Date Building Department Copy March 27, 2018 1 Miami Shores Village /WNU" Building Department M R0 2018 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) btu BUILDING Master Permit No. 9-L 18 —S-11 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑■ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP n r CONTRACTOR DRAWINGS JOB ADDRESS: y `> ► v L City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: I I" 3'0 b 0 1+0(0( C) Is the Building Historically Designated:Yes NO v/ Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name(Fee Simple Titleholder): M i0./m S k Or Z.S �7Phone#: 30 S -75 FS OS 5� Address: 37D Grad' c�o�ua-e city:_N/ &'Vw G�10(es State: 1:'l_ Zip: 3313? Tenant/Lessee Name: Ch r I S -4y GIS o n Phone#: Email: i2crvis10 (�? 6e(tsoLA-th•ne4 CONTRACTOR:Company Name: Potential Difference Inc Phone#: 305-298-7631 Address: 3750 NW 28th Street#421 City: Miami State: FLZip: 33142 Qualifier Name: Steve IversonPhone#: 305-298-7631 State Certification or Registration#: EC-13003380 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 22.S 0 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑■ Repair/Replace ❑ Demolition Description of Work: Replace meter main and ground rods. Specify color of color thru tile: Submittal Fee$ I Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Train I ng/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ I I (Revised02/24/2014) i •Bonding'Company's Name(if applicable) Bonding Company's Address ' City St tae Zip I 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 will be charged. t Signature �`�'V� Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of M Q YCh � 20 1 —,by day of �l�!'tui 20 by t Yl i ` rho is personally known to �°✓z� � �✓ (/ ho is personally known to me or who has oduced 1�ri'v-e V 1 1 OR VIS P as me or who has produced-T � "�- as identification and who did to identification and who did take an oath. NOTARY PU LIC: NOTARY PUBLIC: Sign: Sign: Print: roe v%Seal: Seal: J mlWonfIGG177601 MY COMMISSION#FF 214031 ExMres J0wary 2Z ypn r EXPIRES:March 25,2019 oF�oP� Baid�dilwBuOpdNa4rylNMON .F on4• Bonded Thru Notary Public Underwriters ssssssss*s' 4;i.rsa — ssss*ssss+erss*�ssssssss#ssss*sssss***ss*sssssss***ssssws#**sss*sss APPROVED BY _ 2 Plans Examiner Zoning Structural Review Clerk (R6ised02/24/2014) 4 Property Search Application - Miami-Dade County Page 1 of 1 Aft OFFICE UKEF T11T PIROPEIRTY A Fm Pm R An IS%E R Summary Report Generated On:3/6/2018 Property Information Folio: 11-3206-014-0610 Property Address: 425 NE 95 ST Miami Shores,FL 33138-2729 Owner MIAMI_SHORES_BAPTIST CH Mailing Address 370 GRAND CONCOURSE AVE rt MIAMI,FL 33138-2753 . PA Primary Zone 1000 SGL FAMILY-2101-2300 SQ ` r Primary Land Use 0101 RESIDENTIAL-SINGLE ' FAMILY: 1 UNIT { Beds/Baths/Half 3/2/0 a Floors 1 Living Units 1 ` Actual Area 2,311 Sq.Ft Living Area 1,603 Sq.Ft Adjusted Area 1,997 Sq.Ft Taxable Value Information Lot Size 14,300 Sq.Ft 2017 2016 2015 Year Built 1938 County Assessment Information Exemption Value $546,128 $496,480 $475,447 Year 2017 2016 2015 Taxable Value $0 $0 $0 Land Value $429,139 $357,269 $342,686 School Board Building Value $138,991 $138,991 $138,991 Exemption Value $568,350 $496,480 $481,897 XF Value $220 $220 $220 Taxable Value $0 $0 $0 City Market Value $568,350 $496,480 $481,897 Assessed Value $546,128 $496,480 $475,447 Exemption Value $546,128 $496,480 $475,447 Taxable Value $0 1 $0 $0 Benefits Information Regional Benefit Type 2017 2016 2015 Exemption Value $546,128 $496,480 $475,447 Non-Homestead Assessment Taxable Value $0 $0 $0 Cap Reduction $22,222 $6,450 Parsonage Exemption $546,128 $496,480 $475,447 Sales Information Note:Not all benefits are applicable to all Taxable Values(i.e.County, Previous Sale Price OR Book-Page Qualification Description School Board,City, Regional). Short Legal Description MIAMI SHORES SEC 2 PB 10-37 LOTS 16&17 BLK 53 LOT SIZE 100.000 X 143 The Office of the Property Appraiser is continually editing and updating the tax roll.This website may not reflect the most current information on record.The Property Appraiser and Miami-Dade County assumes no liability,see full disclaimer and User Agreement at http://www.miamidade.gov/info/disclaimer.asp Version: http://www.miamidade.gov/propertysearch/ 3/6/2018 2017 FLORIDA NOT FOR PROFIT CORPORATION ANNUAL REPORT FILED ,DOCUMENT#717306 Jan 26, 2017 Entity Name: MIAMI SHORES BAPTIST,CHURCH'lNC. Secretary of State CC3920548156 Current Principal Place of Business: 370 GRAND CONCOURSE MIAMI SHORES, FL 33138 t ,Current Mailing Address: 1370 GRAND CONCOURSE MIAMI SHORES, FL 33138 'FEI Number: 59-0700565 Certificate of Status Desired: Yes Name and Address of Current Registered Agent: JONES,STEVE H MR. 1060 N.E.92ND ST. MIAMI SHORES,FL 33138 US The above named entity submits this statement for the purpose of changing its registered office or registered agent,or both,in the State of Florida. SIGNATURE: STEVE H. JONES 01/26/2017 Electronic Signature of Registered Agent Date Officer/Director Detail Title •,PRESIDENT Title OFFICER Name MITCHELL;ANTHONY.D 3 Name LUC,MARCEL. Address 125 N.E.86TH STREET Address 141 NW 100 ST City-State-Zip: MIAMI FL 33138 City-State-Zip: MIAMI FL 33150 Title OFFICER Title SECRETARY ,Name CHARLES,GAUDIN Name TURPIN,RICHARD III Address 831 N.E. 142ND STREET Address 25 N.E. 139TH ST City-State-Zip: MIAMI FL 33161 City-State-Zip: N.MIAMI FL 33161 r Title TREASURER Name GODFREY,KAREN Address 1481 NE 102ND ST City-State-Zip: MIAMI SHORES FL 33138 9 I hereby certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath;that I am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 617,Florida Statutes;and that my name appears above,or on an attachment with all other like empowered. SIGNATURE:ANTHONY MITCHELL PRESIDENT 01/26/2017 Electronic Signature of Signing Officer/Director Detail Date r AC40R"® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/05/2018 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 T E'CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les) must have ADDITIONAL INSURED provisions or 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 Susan Gray Argosy Insurance Advisors, Inc. t PHONE (954)540-6141 Fc No): (754)312-7422 P.O. Box 450220 Epp IL , susan@argosyinsurance.com !r INSURERS AFFORDING COVERAGE NAIC# Sunrise FL 33345 INSURER A: EVANSTON INSURANCE COMPANY INSURED INSURER B: TECHNOLOGY INS CO INC 42376 Potential Difference Inc. INSURER c: NORGUARD INSURANCE COMPANY 3750 NW 28th Street INSURER D: #421 INSURER E: Miami FL 33142 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. INSR I ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM DD1YYYY) (MWDDIYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE El OCCUR DAMAGE T RENTED PREMISES Ea occurrence $ 100,000 MED EXP(Any one erson) $ 5,000 A X X 3AA141435 07/21/2017 07/21/2018 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY E PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: o $ AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT $ 1,000,000 I ANY AUTO Ea accident) BODILY INJURY(Per person) $ B X OWNED �/ SCHEDULED AUTOS ONLY X AUTOS X TPP1225354 03/25/2017 03/25/2018 BODILY INJURY(Per accident) $ HIREDNON-OWNED AUTOS ONLY X PROPERTY DAMAGE AUTOS ONLY Per accident) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE r $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBER EXCLUDED? N❑ N/A POWC881459 07/18/2017 07/18/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 1,000,000 If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate holder has been added as an Additional Insured for work performed by the insured under contract. Primary Non-Contributory language is included. EC13003380 CERTIFICATE HOLDER CANCELLATION r SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores Village Building Department ACCORDANCE WITH THE POLICY PROVISIONS.' AUTHORIZED REPRESENTATIVE 10050 NE 2nd Ave. Miami Shores FI 33138 .• ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I s \ivy_�vvvv \ _ \ \\�A •\ V ..rt.� \ RICK SCOTT, GOVERNOR r tia..,o� � �� v ��Vv �A �rh V p�\� �� w Ayv .� •v vv :� v V v" v vvaA�vvvV'��vvav�\ y\vA\VvvVAVAOv as xr\ \ \ \ \ \ \o\\ a\ \ cv v vvv �`v ��AVA�VAOAAV\VA v\ VA wall llvvv\*x*Qv � \� ,_` v - vaavvvvo aDvvV A\\AOno.IVa\ vvvvv'. vvvvv v vvv yvyyovAAv�\vvvav avv�vMmum, a� �• � v ya�� �vvA vHovaA�AAAAAA v v � vvv E � 1 v �h • „�� saw � \ \ ��\ .\\•: \ \ a \ k a v wg�;� to aV �- y V AAA2N, vV� ..............I . N ......... a. sL v13 w* V .\ ,., ai....�RE\..a Ar I jmdm.S�:4 _ Miami Shc;res-Village- - - APPROVED BY DATE f ZONING DEPT Fl Ae-M4 BLDG DEPT SUBJECT TO COMPLIANCE_WITH ALL FEDERAL 425 95 Street ANDCoiINTYR�"_EsPotentia'ITDifference Inc ELC-3-18-577 Miami Shores FL 3750 NW 28th Street 33138 Miami, FL 33142 Riser Diagram - _ 0000 d . . �, � .•. 0000 0000.. •• •• 0000.• r • 0.00•• • Rigid :..... • •0000 . '.0• •s• Ii 60.00• • • •.:••� :r • . . • 0.0.00 • • 0 r •• • e'* � p 29 D` re.'', • • 600000 06000 s 2" PVC interior �� • ' .6..•• 2/0 feeder N. "f! 000.00 41 �- �CI�oo33 �a 3 •vZo M > _ ,31.2 M / N JJ W m v R00%. Notary Public Stale of Fimida Peggy E Grant My Commission FF 960223 a� etpitesO 2012020 € k •• •• • • • •• •• • . . . ... . . . . ... . . . . . . .. . . r-PL. ... ... . March 9, 2018 •• •• •• U Miami Shores Baptist Church 370 Grand Concourse Miami Shores, FL 33138 Re: 425 NE 95th St i DISCONNECT NOTICE: IMMEDIATE ACTION REQUIRED Warning— Reminder of the issue with your electrical equipment Dear Miami Shores Baptist Church: You were previously notified of a condition affecting the meter enclosure at the above referenced address. f Our records indicate that as of March 9, 2018 you have not completed the necessary repairs to your meter can, which is your equipment that houses the FPL electric meter. If left unrepaired, meter enclosures in poor condition can lead to power quality issues, such as flickers or outages, and, in some cases, can cause fire hazards to your premise. This letter serves as a Final Notice that your service will be disconnected after March 16, 2018. This is necessary to ensure the safety of you, your equipment and our employees in accordance with Rule No. 25-6.105 (5) (b) Florida Administrative Code. To avoid disconnection, we suggest that you contact a licensed electrical contractor to perform the repairs as soon as possible, and obtain the appropriate permits and electrical inspections required by f the city or county in which you live. Prior to beginning any repairs, you will need to call FPL at (305) 770-7902 to schedule appointments to disconnect your electric service, allowing time for the repairs to take place, and to reconnect your service when the repairs are complete. You should also contact us at this number if you need additional time to make the repairs. The electric inspection, if required by the city or county in which you live, must be reported to FPL prior to the reinstallation of our meter. Your prompt attention to this matter is appreciated so we may continue your electric service. If you have questions, call FPL at the number above. If we can't resolve your concern, you may call the Florida Public Service Commission at 1-800-342-3552 in accordance with the Florida Administrative Code. Sincerely, Florida Power& Light Company + t Florida Power&Light Company 700 Universe Boulevard,DOE/JW,Juno Beach,FL 33408 4 v„ t A .R ayh � tq 3 I ACD7591 s # 0. 4i161tiM J u Ilk • i .: i { E 4;y T s It � � 7 �3 i s 4 AW. j4Y IF b aye. —7-7- , t .t A c Yi • i k l � * _�K4 , y� -..,.§fir° mF "'_ � ti i &(�•�!' 'ir ! 1M!� �'8 Miami Shores Village Citizen Access Portal Page 1 of 1 . • ••. . . • %. .. .. . . . .. .. . . . . . . . . . . . • ••. . • • • • • • . • Nfiami 4 F �.euxM^y.*" ,'.. . • • � • � Ir-; • ttp�•e[�iz�u�i�r�.portal EnerGov Citizen Access • is • • • is • • • • Account login000 0 000 0 't Home Welcome,Steve Iverson About Citizen Access My Home Page Lo9,D�it Search My Permit W Detail Information • • • • • • • • • ❑ Chance my oassvrord. Submit Request Inspection#: INSP-298x66 •Type:is • is Refiev+Electrical • Search Property P c IjsWt#ases are General Information View w Status: DENIED Completed: plan applications are attached to your account. Date Completed: 3/12/2018 Inspector: Michael Devaney Cell Phone: Email: li licenses are attached to your account. ddress: EW"es Miami Shores,FL easons&Comments Pawit View Comments EVIEVI� � IssuecNeeE)ipdDdaqrarTftAn9I schelAnand Invoice load calculcalion. E e tial View , �ecently Completed Inspections Insp# Completed Permit ft Type Status Address INSP-298766 3/12/2018 ELC�3-18-577 Review Electrical DENIED _ 42595 Street No upcoming inspections are attached to your account. I E-mail your rnmrnenls or questions ebcut the site to Contact."Q—ail com Repon technical prob?ms•with this site 10 help*,n)e.mail.aom This is the offr,ial web site for Man;Shines Viliage Gotremmenl.Ccpyrignt- 20002005,M ani Ail rights reserved. 1 https://bldg.miamishoresvillage.com/cap%default.aspx 3/19/2018