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ELC-18-2513 (2)Miami Shores Village 10050 NE 2 Ave Miami Shores Village FL 33138 305-795-2204 Location Address 9050 BISCAYNE BLVD, Miami Shores, FL 33138 Contacts jt Permit NO.: CLC-09-18-2513 Permit Type: Electrical - Commercial IP,_I 1_ �tJ work Classif cation: Addition/Alteration Permit Status: Approved Issue Date:09/24/2018, Expiration:03/25/2019 Parcel Number Project 1132060100010 <NONE> PUBLIX SUPERMARKETS, INC Owner PUBLIX SUPERMARKETS, INC Applicant P 0 BOX 407, LAKELAND, FL 338020407 P 0 BOX 407, LAKELAND, FL 338020407 863688747 863688747 C DAVIS ELECTRIC COMPANY, INC Contractor (954)432-4334 �® Inspection Requests: Description: SUB ELECTRICAL FOR PUBLIX 794 Valuation: $ 184,400.00 Inspec i n Re 49 Total Sq Feet: 19,700.00 Fees Amount Application Fee - Other $50.00 CCF $111.00 DBPR Fee $96.81 DCA Fee $64.54 Education Surcharge $37.00 Permit Fee $6,404.00 Scanning Fee $3.00 Technology Fee $161.35 Total: $6,927.70 Payments Amt Paid Inspections: Total Fees $6,927.70 Inspection Type Check #74858 $6,927.70 Electrical Final Amount Due: $0.00 Permit Received By Date Building Department Copy 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 reVu truction and zoning. Futhermore, I authorize the above named contractor to do the work stated. P� 6ei�l�d 9-Z�-I � Signature: Owner / Applicant / Contractor / Agent Date September 24, 2018 Page 2 of 4 e \ BUILDING PERMIT APPLICATION ^CN Miami Shores Village Sr- 2 0 RFCEIVED Building Department s�P z o 2;� 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 ��- Master Permit No. CC-4-18-902 Sub Permit No. T—w,(e - 1,66� ❑BUILDING ❑■ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION DRENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS [:]CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9050 BISCAYNE BLVD City: Miami Shores County: Miami Dade Zip: 33472 Folio/Parcel#:11-3206-010-0010 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): PUBLIX SUPERMARKETS INC. Phone#: 863-688-1188 Address: 3300 PUBLIX CORPORATE PKWY City. LAKELAND State: FL Zip: 33811 Tenant/Lessee Name: Phone#: r Email: CONTRACTOR: Company Name: C. DAVIS ELECTRIC CO. INC Phone#: 954-432-4334 Address: 1701 SW 100 TERRACE City: MIRAMAR State: FL Zip: 33025 Qualifier Name: 66,S E. Ony,3 Jr- Phone#: 954-275-6004 State Certification or Registration #: ' LODD 10 3 8 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ 184,400 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑■ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: SUB ELECTRICAL FOR PUBLIX 794 Specify color of color thru tile: 6, ` o �( • Q Submittal Fee $ Permit Fee CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ IqG Notary $ Technology Fee $ Training/Education Fee $ Double Fee $ Structural Reviews $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 I J OWNER or AGENT The foregoing instrument was acknowledged before me this 1 day of `P p f 20 , by a� .\c0P-A Sex- who personally known me or who has produced as t Signature CONTRACTOR The foregoing instrument was acknowledged before me this 20 day of ,20 ) 8 by Gtia✓l� 00-5- Jr. who personally known t 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: \ Si Print: -k�) \OLrc '3-,oc,X ��yKr Print: �� ✓L��Y� Seal: Seal: �� DOUGLAS E. BERNARD, SR. ,1►?� ;�� DIANA $HECKLER Commission # FF 899572 Commission k GG 230606 `'� k4 Expires July 14, 2019 M, Expires June 19, 2022 9au.d TMu T oy Fyq Neurone 800.3&i70f9 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) Return to: Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Bill To PUBLIX SUPERMARKETS, INC PUBLIX SUPERMARKETS, INC P O BOX 407 LAKELAND, FL 33802-0407 Invoice Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138-0000 Phone: (305)795-2204 Fax: (305)756-8972 For Inspections please call: (305)762-4949 Permit Number: ELC-9-18-2507 Invoice Date: September 20, 2018 Invoice Number: ELC-9-18-68949 Bond Number: Comments: Permit Type: Electrical - Commercial / Work Classification: Date Fee Name Fee Type Fee Amount 09/20/2018 Permit Fee Percentage $5,532.00 09/20/2018 CCF Calculated $111.00 09/20/2018 Education Surcharge Calculated $37.00 09/20/2018 Scanning Fee Fixed $3.00 09/20/2018 DCA Fee Calculated $55.32 09/20/2018 Technology Fee Calculated $148.00 09/20/2018 DBPR Fee Calculated $82.98 Total Fees Due: $5,969.30 Thursday, September 20, 2018