ELC-19-357sic a
Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Location Address
Issue Date: 02/21/2019
Parcel Number
9050 BISCAYNE BLVD, Miami Shores, FL 33138 1132060100010
Contacts
Permit No.: ELC-02-19-357
Permit Type: Electrical - Commercial
Work Classification: Alteration
Permit Status: Approved
Expiration: 08/20/2019
PUBLIX SUPERMARKETS, INC Owner PUBLIX SUPERMARKETS, INC Applicant
PUBLIX SUPERMARKETS, INC PUBLIX SUPERMARKETS, INC
P 0 BOX 407, LAKELAND, FL 338020407 P 0 BOX 407, LAKELAND, FL 338020407
Other:863688747 Other:863688747
10HNSON CONTROLS SECURITY Contractor
SOLUTIONS LLC
DAVID ZACHRY
3054 CORPORATE WAY, MIRAMAR, FL 33025
Business: 9546249824 outi.battenfield@jci.com
Mobile: 9546249846
Description: 1 POWER SUPPLY 3 STROBE 10 DUCT SMOKE 5 Valuation: $ 13,031.00 Inspection Requests:
RELAY
Total Sq Feet: 791.00
Fees
Amount
Application Fee - Other
$50.00
CCF
$8.40
DBPR Fee
$5.86
DCA Fee
$3.91
Education Surcharge
$2.80
Permit Fee
$340.93
Scanning Fee
$36.00
Technology Fee
$9.77
Total:
$457.67
Payments
Date Paid Amt Paid
Total Fees
$457.67
Credit Card
02/21/2019 $407.67
Credit Card
02/14/2019 $50.00
Amount Due:
$0.00
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
regulating_.gonstruction ano-lbning. Futhermore, I authorize the above named contractor to do the work stated.
Authorized Signature: Owner / Applicant / Contractor / Agent Date
February 21, 2019 Page 2 of 2
0
BUILDING
PERMIT APPLICATION
❑BUILDING Q ELECTRIC
iy'I 2-)Foy 4, .
Miami Shores Village
Building Department RECEIVE®
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 FEB(� jti�C/J, O119
Tel: (305) 795-2204 Fax: (305) 756-8972 _ /
INSPECTION LINE PHONE NUMBER: (305) 762-4949
FBC 2019- q
Master Permit No. CC - I/' /.F" ! v�
Sub Permit No. E 1 C !a - 3S
❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL
❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF
G� CONTRACTOR
JOB ADDRESS: / -o�
❑ CANCELLATION ❑ SHOP
DRAWINGS
Qp < i/. 3.3
/
1 1 _ 1 `-0 I/
5 Folio/Parcel#: l `' W�e — Q `� (�� Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FIFE:
OWNER: Name (Fee Simple Titleholder): �O �� C `e ( V\ 1 7 \ ` /fit ?iv— Phone#:
Address: 4 b )o-. !)u 1/ti
City: \-uke l cAzs d State:
Tenant/Lessee Name:
Email:
*�16D
CONTRACTOR: Company Name: JOHNSON CONTROLS SECURITY SOLUTIONS phone#: 954-624-9824
Address: 3054 Corporate Way
City: Miramar State: FL Zip: 33025
Qualifier Name: David Zachry Phone#: 954-624-9846
State Certification or Registration #: EF0000478 Certificate of Competency #:
DESIGNER: Architect/Engineer:
hone#:
Address: City: State
OJ
Value of Work for this Permit: 13 o Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace
Description of Work: /— y&i e S�ijay. . 3- s%,eoef—, lo- Duc—f wo e �
Specify color of color thru tile:
Submittal Fee $ Permit Fee $
Scanning Fee $
Radon Fee $
Technology Fee $ Training/Education Fee $
Structural Reviews $ _
CCF $
Zip:
❑ Demolition
46� kle-
Co/CC $
DBPR $ Notary
Double Fee $
Bond $
(Revised02/24/2014)
TOTAL FEE NOW DUE $ '::� • b-':)
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 #— Y
OWNER or AGENT
The foregoing instrument
`was
`acknowledged before me this
day of �C 20 17�K� by
who ersonally known o
me or who has produced
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Seal: DIANASHECKLER
t'"Commisslon # GG 230606
, * Explres June 19, 2022
APPROVED BY `! 0- • G-D5A
as
Signature
�OACTOR
The forego_ i .nstrument was acktoi
ed before �, this
day of by
AVID ZACHRY ersonalI know
me or who has produced as
identification and who did take an oath.
•
► IF
MY COMMISSION # GG 2328n
EXPIRES: July 1?, 2022
Bonded T ru Notary Pubfic UiWerwrltM
lans Examiner Zoning
(Revised02/24/2014)
Structural Review
Clerk
CERTIFICATE OF SECRETARY
(AUTHORITY OF DIRECTOR OF CONSTRUCTION)
THE UNDERSIGNED, being the Secretary of PUBLIX SUPER MARKETS,
INC., a Florida corporation (the "Corporation"), hereby certifies, on behalf of the
Corporation and its subsidiaries, that MIKHAEL H. SER, P.E., as the Director of
Construction of the Corporation, is authorized to do all acts and execute all documents
(including, without limitation; permit applications and notice of commencement
documents) with respect to the construction, alteration, and installation of improvements
and equipment for facilities owned, leased, or otherwise controlled by the Corporation,
on behalf of the Corporation, as fully as the Corporation might or could do through its
officers.
DATED this -?r day of January, 2017.
John A.
'r- VVL M4
[C
va
DEC. 27, 1921
`'� • " r)
•
STATE OF FLORIDA '.w.''°• SEAL '
COUNTY OF POLK
The foregoing instrument was signed, sealed, and acknowledged before me this
day of January, 2017, by John A. Attaway, Jr., as Secretary of Publix Super
Markets, Inc., a Florida corporation, on behalf of the corporation. He is personally known
to me.
Printed Name:
My Commission Ex ices:
Commission Number: 1K 1250 2
(Notary Seal)
4211% JOYCE M. PAFMSH
MY COMMISSION N FF129022
a
EXPQt6S: June OR, 201$
Johnson �j ADMIN Order Entry Form
� ,�
Controls y
9 1 5 0 U E 0 0
Town# Customer# Job# Siebel Customer Id Estimate Name Estimate #
0149-MIAMI, FL 114927904 16 1-3RODWVQ Publix P0794 Remodel 1-3R366U6 1-3R366U6
New Customer N
Update Customer Info N Multi-Loc 00000968
Previous Customer Transaction Type 01 - New Contract
Service Location
Company Name
Publix Super Markets INC.
d/b/a
Publix #0794
Address Line 1
9050 BISCAYNE BOULEVARD
Address Line 2
Address Line 3
City
MIAMI SHORES
Contact
Store Number
0794
Telephone Number
8636868754
Fax Number
8632845554
Business Id
1400 - National Account
Business Sub Id
Retail
Billing Info
Recurring
T&M
Other
All Type
Invoices
State FL
Zip 33138
Bill To Address
Company Name
Address Line 1
Address Line 2
Address Line 3
City
Contact
Telephone Number
Billing Tel#
Fax Number
Publix Super Markets INC.
PO Box 32014
Attn: Expense Accounting -Buyer 00105
Lakeland
8636868754
8632845554
Tax Exempt Info
Tax Exempt Flag N
Tax Exempt Reason
Tax Exempt Number
Tax Exempt Expiration Date
State FL
Zip 33802
Site Info
SIC Code 2000
D&B No
NA# 006922009
Lead Source 010 -SALESMAN CONTACT
Report Generated for: RKILCREASE on: 08/24/2018 Estimate#: 1-3R366U6 Rev#: 1 Page 1 of 7
Johnson // ,��
J ,�
Controls
Installation Price Components
Estimated Labor Hours 78
Production
001 - LABOR
002 - MATERIAL
010 - OTHER CHARGES
Total Production Book
Material Load
Sub Contractor Load
NA/CC Load
Total Non Production Book
Sub Contractor Load
Non Production
Sys Gen
ADMIN Order Entry Form
$11,466.00
$4,466.07
$3, 526.60
$19,458.68
$81.71
$0.00
$926.60
$0.00
$0.00
$13,031.55
'Loads are at Book Price and included in corresponding Charge Codes
*Loads are at Book Price and included in corresponding Charge Codes
Report Generated for: RKILCREASE on: 08/24/2018 Estimate#: 1-3R366U6 Rev#: 1 Page 3 of 7