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EL-18-1614Miami 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 BUILDING PERMIT APPLICATION El BUILDING ED ELECTRIC ROOFING ❑PLUMBING El MECHANICAL p PUBLIC WORKS JOB ADDRESS: 9705 NE 2nd Ave. City: RF-C17, � JuN 12 20M8 BY: �/a1n ,i FBC 201 i 411 Master Permit No. 77L !. ~ (a- -13 -2v3 Sub Permit No. tL t 8 - (6 I 4 ❑ REVISION ❑ EXTENSION El RENEWAL [] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS Miami Shores County: Folio/Parcel#:11-3206-013-4230 Occupancy Type: Load: Construction Type: Miami Dade Zip: Is the Building Historically Designated: Yes NO OWNER: Name (Fee Simple Titleholder): Cochran Miami Shores Address:1800 Eller Drive, #212 City: Fort Lauderdale State: Florida Flood Zone: BFE: FFE: Phone#: 954-760-4360 Zip: 33316 Tenant/Lessee Name: Phone#: Email: Bobbie@Fitzgeraldgroup.com CONTRACTOR: Company Name: (PO / n 1 Laakira_dicr Phone#: 30 r' - o Jr" } Address: / 9 T O (5_Lf C,, urcf City: a c-at-U., ' State: Q r�- Zip: 33 O/u Qualifier Name: �i J 1 / j�4./O-.9t Phone#: State Certification or Registration #: e C / 3 d el 17c—/ Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: Value of Work for this Permit: $ Of/ -90 0 State: Zip: Square/Linear Footage of Work: Type of Work: ❑ Addition ❑Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: cksha1/(:1-0-4- 004"-PJ SL'Gy, Q,lra Specify color of color thru tile: Submittal Fee $ S 0l l L'I Permit Fee $ /! D' '' b Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ CCF $ CO/CC $ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address. City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address 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. Signature OWNER or AGENT The foregoing ins rument was acknowledged befor , 20 'C _t A . S , wlho is personally known to me or who has produced identification and CONTRACTOR me this The foregoing instrument was acknowledged before me this ,20 L7 ,by (q , who is personally known to by Print: Seal: as r: "." VktRaDSERIM SCHWESTER `' c MY COMMISSION # FF982299 'r EXPIRES April 30, 2020 053 florkWNOW c_.. ...:� day of k-riA..5E- me or who has produced as identification and who did take an oath. NOTARY Sign: Print: r� SL%I r 11° Seal: i 1 1i2111111 'rli' KA ` . odA SSION #FF155823 eptember 1, 2018 APPROVED BY %Z l3 ► iAri/tans Examiner Zoning (Revised02/24/2014) Structural Review Clerk Cc E LQ c_4- r cA I -kr,4„ cko v• L L "PQ ct7o y a F 177VZ 5 .E0 v e v' e , -(,A') \I ke, ,cLot,-) v ice. a 1„,,,e,4- 1 �c 0 Or t Gas 5a.5 & ad- Voa-K,6_,)1 Qt a \J e_, , C k-LV 0 r c-L) \r-e, o,r 1ti - -c Cm at" CC e 2st5r 'r: IFfo 1 4!0 Prz_ Notary public State of Pond: 11 Helsel MareZ �•/ I My Commission G nnlr tr Expires At it/ 1/fLei�}luGuZ 4 r ) vtd\g_ -\--\1417 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part -rime or full-time employees, including the owner, must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The' officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC, a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State, Division of Corporations; and 3. The corporation is registered and listed as active with the Florida Department of State, Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor, part -rime employees or subcontractors for your project. The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances, Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor, part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: State of Flori County of Miami -Dade �^ n The foregoing was acknowledge before me this 1 J day of A , 20 1F) who is personally known to me or has produced as identification. SEAL: ;•►"' ROBERTA SCHWESTER MY COMMISSION # FF982299 EXPIRES April 30, 2820 (407) 398-0153 FlorldallotaryServioe.eom Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - DO NOT PAY 7258955 ` BUSINESS NAME/LOCATION GOLDEN ELECTRICAL CONTRATOR LLC 19407 NW 82ND CT MIAMI, FL - 33015 OWNER GOLDEN ELECTRICAL CONTRATOR LLC C;/O (I AI IRFRT RFC4AI nr .IR Worker(s) 1 RECEIPT NO. NEW BUSINESS 7545559 SEC. TYPE OF BUSINESS 196 ELECTRICAL CONTRACTOR EC13008451 / 1 LBT EXPIRES SEPTEMBER 30, 2018 Must be displayed at place of business Pursuant to County Code Chapter 8A - Art. 9 & 10 PAYMENT RECEIVED BY TAX COLLECTOR 75.00 06/11/2018 0208-18-006351 This Local Business Tax Receipt only confirms payment of the Local Business Tax. The Receipt is not a license, permit, or a certification of the holder's qualifications, to do business. Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT NO. above must be displayed on all commercial vehicles - Miami -Dade Code Sec 8a-276. MIM1AMHwD For more information, visit www.miamidade.gov/taxcollector RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY EXPIRATION DAT:ti AUGUST 31, 2020 Always verify licenses online at MyFloridaLicense.com Do not alter thiS document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. 15_1 Florida JIMMY PATRONIS CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION * * CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS' COMPENSATION LAW * * CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: 6/6/2018 EXPIRATION DATE: 6/5/2020 PERSON: GLAUBERT REGALADO JR EMAIL: GL•AUBERTREGALADO@GMAIL.COM FEIN: 823086218 BUSINESS NAME AND ADDRESS: GOLDEN ELECTRICAL CONTRACTOR LLC 19407 NW 82ND COURT HIALEAH, FL 33015 SCOPE OF BUSINESS OR TRADE: Licensed Electrical Contractor IMPORTANT: Pursuant to Chapter 440.05(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.05(12), F.S., Certificates of election to be exempt... apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S., Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS? (850)413-1609 DATE (MM/DDIYYYY) 06/12/2018 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 THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(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 (786) 573-4485 Insurance NOW Agency 12915 SW 132 Street suite 4-B Miami, FL 33015 INSURED Golden Electrical Contractor, LLC 19407 NW 82nd Court Hialeah, FL 33015 (786) 573-4486 COVERAGES CERTIFICATE NUMBER: CERTIFICATE OF LIABILITY INSURANCE NTACT NAME: Stephanie Garcia PHONE A//'Ext. (786) 573-4485 FAX MAIL (Arc No): (786) 573-4486 ADDREss: Stephanie@insurancenowagency.com PRODUCER CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE INSURERA: Western World Insurance Company INSURER B : INSURER C: NAIC # INSURER D INSURER E : INSURER F 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 ADDL SUBR LTR TYPE OF INSURANCE INS y�IVD POLICY NUMBER POLICY EFF POLICY EXP LI (MM/DO/YYYY) (MM/DD/YYYY) A `— t COMMERCIAL GENERAL LIABILITY CLAIMS -MADE / i OCCUR GENERAL LIABILITY GEN'L AGGREGATE LIMITAPPLIES PER: it I POLICY r TA,J LOC I AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS ONHDZ-A 6/5/2018 6/5/2019 (Ea accident) EACH OCCURRENCE DAMAGE T RENTED PREMISES (Ea occurrence) LIMITS ..00.000 $ 100,000 'MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ ' 0,000 GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ 300,000 BI/IUD Deductible $ 500 COMBINED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY. (Per accident) $ PROPERTY DAMAGE (Per. accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAMS -MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' UAB€UTY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER,MEMBER EXCLUDED? (Mandatory in NH) I€ • es, describe under DESCRIPTION OF OPERATIONS below EACH OCCURRENCE AGGREGATE $ $ YIN N/A DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) License #EC13008451 CERTIFICATE HOLDER 1 WC STATU- TORY LIMITS OTH- ER $ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT I $ CANCELLATION Miami Shores Village 10050 Northeast 2nd Avenue Miami Shores, FL 33138 ACORD 25 (2009/09) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AU ORIZED REPR SENTAT€VE The ACORD name and logo are re ere ©19 m Stephanie Garcia -2009 ACORD CORPORATION. All rights reserved. s of ACORD EXISTING METER CENTER EXISTING 150A 2P BRANCH CIRCUIT BREAKER SERVING EXISTING PANEL A • nq I • • EXISTING 3#1 /0 1-1 /2"EMT EXIST PANEL A NEW 30A, 2P NEMA-3R DISCONECT SWITCH NEW 3#10 IN 1 /2" EMT ELECTRICAL RISER DIAGRAM N.T.S. EXISTING PANEL AMPS VOLTAGE CIRCUITS WIRE PHASE AWN/ANC MOUNTING LOCATION CATALOG NUMBER A 150 120/240 12 3 1 LUGS ONLY - - LOAD CENTER CKT. NO. WIRE COND INCH CKT BKR SERVING WATTS CKT. NO. WIRE COND INCH CKT BKR SERVING WATTS POLE AMPS POLE AMPS 1 - - 1 20 EXISTING GEN UGHTING 1000 2 - - 1 20 EXISTING GEN UGHTING 1000 3 - - 1 20 EXISTING GEN UGHTING 1000 4 - - 1 20 EXISTING GEN UGHTING 1000 5 - - 1 20 EXISTING GEN UGHTING 1000 8 - - 1 20 EXISTING GEN LIGHTING 1000 7 10 1/2 2 30 NEW PUMP CNTL PAIL 2000 8 - - 1 20 EXISTING GEN LIGHTING 1000 9 10 - - - - SPACE - 11 - - - - SPACE - 12 - - - - SPACE - TOTAL 5000 TOTAL 4000 TOTAL WATTS UNE TOTAL AMPS UNE TOTAL WATTS NEUTRAL TOTAL AMPS NEUTRAL 9000 38 7000 29 FEEDER THHN CU: SEE RISER DIAGRAM SIEMENS. GENERAL ELECTRIC OR SQUARE-D WILL BE APPROVED. CATALOG NUMBER SHOWN: EXISTING fzO MN 0 >- m APFROtiED ZONING DEPT ELECTRICAL NOTES: 1. ALL WORK SHALL BE IN ACCORDANCE WITH THE NEC 2015, THE FLORA BUILDING CODE 2017. 8TH EDTION AND OTHER APPLICABLE CODES AND STANDARDS. 2. THE CONTRACTOR IS RESPONSIBLE FOR EVA DATING EXISTING FIELD CONDITIONS BY VISITING THE SITE AND REPORT ANY DISCREPANCIES TO THE ENGINEER, PRIOR TO COMMENCING/BIDDING WORK. 3. THE CONTRACTOR SHALL SATISFACTORILY REPAIR/REPLACE EQUIPMENT STRUCTURE DAMAGED OR PART OF AS A RESULT OF HIS WORK. SURFACES AND FINISHED AREAS SHALL BE RESTORED TO MATCH ADJACENT AREAS. 4. APPROVAL SHALL BE OBTAINED FROM THE ENGINEER PRIOR TO CUTNc OR DRILLING ANY STRUCTURAL SUPPORT MEMBER. 5. ALL DEVICE BOXES SWILL BE INSTALLED FLUSH AND CONDUITS RUN CONCEALED IN FINISHED AREAS EXCEPT AS SPECIFICALLY SHOWN, NOTED OTHERWISE OR APPROVED BY ARCHITECT. INSTALL POWER AND CONTROL WIRING & REQUIRED CONTROL COMPONENTS FOR AIR CONDITIONING SYSTEMS AS SHOWN/ NOTED ON THESE DRAWINGS AND PER OTHER APPUCABLE DRAWINGS/ INSTRUCTIONS. SEE AIR CONDITIONING DRAWINGS. e. • • • V 4- • t. • .••• 7. ALL MATERIALS REMOVED SHALL BE DISPOSED OF AS DIRECTED • • BY OWNER. • • • • 8. MINIMUM WIRE SIZE SWILL BE #12 THHN/THWN UNLESS OTHERWISE NOTED ON PLANS. CONDUCTORS #8 AND LARGER SHALL BE THW. 9. ALL CONDUCTORS SHALL BE COPPER. 10. ALL CONDUCTOR SHALL BE RUN IN CONDUIT (METALLIC TYPE). ▪ •a••• • • •• •• • + • • • • • r• 11. ALL MATERIALS SHALL BE U.L APPROVED. 12. ALL BRANCH CIRCUITS SHALL BE PROPERLY PHASE BALANCED. 13. UNLESS NOTED OTHERWISE. ALL UGHT FIXTURES AS SELECTED BY OWNER. INSTALLED BY THIS CONTRACTOR. 14. ALL EMPTY CONDUITS TO BE PROVIDED WITH NYLON PULL STRINGS. 15. FUSES SHALL BE DWI. ELEMENT TIME DELAY TYPE. UNLESS OTHERWISE NOTED. 16. ALL WORK SHALL BE DONE IN A NEAT AND WORKMANLIKE MANNER. 17. CONTRACTOR SHALL COORDINATE ALL HIS WORK WITH OTHER TRADES IN ORDER TO FURNISH AND INSTALL ALL CONTROL WIRING AND RACEWAYS AS SHOWN ON THE AIR CONDITIONING DRAWINGS OR SPECIFICATIONS. IF AIR CONDITIONING DRAWINGS REFER TO MANUFACTURER'S WIRING DIAGRAMS, THE CONTRACTOR SWILL VERIFY WITH SAID MANUFACTURER ALL REQUIRDMENTS AND INCLUDE ALL RELATED WORK IN HIS CONTRACT. 18. EXACT POINT AND METHOD OF CONNECTIONS SHALL BE DETERMINED IN FIELD. 19. RISERS ARE DIAGRAMMATIC ONLY. THEY DO NOT SHOW EVERY BEND REQUIRED FOR THE INSTALLATION. 20. THIS DRAWING IS A GUIDE FOR THE INSTALLATION OF ELECTRICAL SYSTEMS. THE ELECTRICAL CONTRACTOR IS RESPONSIBLE TO PROVIDE A FUNCTIONING SYSTEM. 21. ALL CABLES SHALL BE RUN WITHOUT SPLICES EXCEPT OTHERWISE INDICATED. 22. ALL PULL AND JUNCTION BOXES SWILL BE ACCESSIBLE AT ALL TIMES. SCOPE OF WORK PROVIDE NEW ELECTRICAL CONNECTION TO PUMP CONTROL PANEL. M MA Z Oa_ U D W a_ Z Z >- O< ••t+ I- • J•Z • tr •Q • Is -Et O • • •Ala'. 4J_ • •• 1.4 • • • • •� • • r •. • • a ,14•4‘ 411 CTS q.„ li • • �o • fn an • z ; W (Y),� W 7cw ZI— Z Q. w U�U_ .E amp i W0 MOJ U� U to 1- r w in J w M N 0 Pig DAAE ISSUED 6.0920! SHEET E-1