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ELC-12-430Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 LL cc- 12 - B'to Inspection Number: INSP- 171019 Permit Number: ELC- 3- 12-430 Scheduled Inspection Date: June 28, 2012 Permit Type: Electrical - Commercial Inspector: Devaney, Michael Inspection Type: Final Owner: MIAMI SHORES LLC, COCHRAN Work Classification: Addition /Alteration Job Address: 9705 NE 2 Avenue Miami Shores, FL Project <NONE> Contractor: RICKYS ELECTRIC COMPANY Phone Number Parcel Number 1132060134230 Building Department Comments REMOVE AND REPLACE KITCHEN AND BATH FIXTURES AND CABINETS Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments feeP June 27, 2012 For Inspections please call: (305)762 -4949 Page 2 of 24 Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit No. Master Permit No. MA l ix Fi;.LCt(2_, -H30 ccA ` 2 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder):CC \- A j M I(3611t, Shams Phone #:4 ' 74'O a S(e (� Address: SOC' E LL ea_ D21 V a , 2,2_ 2 City: - Lqune Q.O Al, C' State: Pt_ Zip: 35Sk Tenant/Lessee Name: h % / P Phone #: Email: Sh P S'� TZL eziaL0 E? •� (� t O% t4 (97 AA ,F, (A . 4ef aoq JOB ADDRESS: —`�� _--- ---^* "F----'"' City: Miami Shores County: Folio/Parcel #: \ \ - 3 /AD m `� L 12 S Miami Dade Zip: 331 '� g Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: `1 tic y) ��/r 7i/ C. Phone #: Address: %0 3 & 41u W (� Top. / i City: Pat rh by,ri State: /. Zip: 3306 Qualifier Name: S {C R4' C I Phone#: .N9 gsry i; -03'669 State Certification or Registration #: 1✓ / .� Ccoitit -%if Certificate of Competency #: Contact Phone#: S ei P - - ° Email Address: - 3 S Ct o i. e. con DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ Q Square/Linear Footage of Work: Type of Work: (]Address OAlteration ONew� " ` ORepair/Replace ODemolition Description of Work: Q e e c C icy K-% `#CAr1t r- Our( IOGLAVI Submittal Fee $ Permit Fee $ /t> CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ , 0°1 -10 Bonding Company's Name (if applicable) J/ A 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 FT.RCTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occ s en (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be a`ppr, ' . , d . 'einspection fee will be charged. Signature /s/ y Signature /Owner or Agent & � . The fore got e go :�,,. trument was acknowledged before me this CP day of t4...0-.et. , 2012, by `t ui - ' me or who has produced who is personally known to meeor who has produced Contractor The foregoing instrument was acknowledged before me this , day of _ by As identification and who did take an oath. NOTARY PUBLIC: Sign: sr�t�L'r�1.0 Print: L. 1 L. VV1 SCA ( t My Commission Expires: as identification and who did take an oath. NOTARY PUBLIC: Sign: / Print: /4 - �A A. 'J op' j.V s' My C (Revised 07 /10/07)(Revised 06 /10 /2009)(Revised 3/15/09) 0 4 '1/RCELLA L HOPKINS ie: MY COMMISSION # DD779678 p RFc � 53 * *n�UF�ki'ER�R6a r" "*** Zoning Clerk 05/17/2011 11:05 30155181119 September 23, 2011 COCHRAN COCMAN MINIM SHORES, LW I ROO Eller Drive, Suit 222 Port Lauderdale, FL13316 954460-4360 PAM 01 City or Miami Shores! Please utilize this letter as authority tbr Shelby 0. Smith to execute documents related to our property located at 9701-9711 NE 7'h Avenue and 211.217 NE 97$I Street, Miami Shores. Such documents shall be limited to Permit Applications and related documents: Violation Corrective Actions: and other city documents required within the normal day to day operation areal estate. This document shall soot be used to commit tha property or its owner/s ander any mortgage andier ion% Should there be any questions. please ibel free to contact the car rate representative at Cochran Miami Shores, LLC C-Orjvtart,a-i Shells Cochran, as Trustee I codify offer pond* of perjury that this document has been ea oiled by the individual mferenced above. Miami Shores Viiiage Building Department 10050 N.1.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 7952204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION FORM ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR. IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR; A. ''COPY OF QUALIFIER'S STATE LIC CARD B. - /COPY OF LOCAL BUSINESS TAX RECEIPT C. DOPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 COMPLET? CONTRACTOR'S INFORMATION BUSINESS NAME: Ity c. Co BUSINESS ADDRESS: 6006 w 6 4 `7 (. CITY Ar4 STATE H. ZIP CODE 33O BUSINESS PHONE: ('irY ) 'j —CU-4U FAX NUMBER (/CY) 0)1/ CELL PHONE ( ) QUALIFIER'S NAME: Skpi m ►'C G% QUALIFIER'S LIC NUMBER: £!✓ I CO? A yL/t E -MAIL ADDRESS (IF APPLICABLE): Created on 3119109 BY MLDV 1 RV 3126109 MLDV This certifies that ■ • • • Certificate of Insurance State Farm sits and Casualty Company, etomngion, Undo State Farm Genital Mammies Company, Bloondngton, Snob State Farm Firs and Casualty Company, Aw re, Maxis State Farm Florida Insurance a Cam, maw Haven, Florida Sys Farm Lloyds, pew. Tee Muses the following poky/Oder for - the indicated below. Poleyholder RICKY'S CO Address of popeyhoider 8888 NW 8 3 tit PARKLAND FL 330671426 Location ofd Orr of openstkere TTY policies listed below have been issued to the polleyholder for the policy periods shown. The insurance desonled in these policies is subject to all the fauns, exclusions. and conditions of those policies. The limits of liability shown may have been reduced by any paid gains. Policy Period ! Limbs ofL Polley Number Type of Insurance Effective Date Expiration Dade (at beginning of policy period) 88.BNE -278.2 Comprehensive 10/2012011 10/2012012 • BODILY INJURY AND liminess Liability PROPERTY DAMAGE This Rene includes: Products - Completed trw ral Li r wes o Pervonal injury Advertising injury Eadr °costuoe General Aggregate Product Completed Pocky Number EXCESSUAIEUTY Phi mod Effective Date . ❑ tintveNa Other Poflr Effective Date $ 100,000,000.00 $ 200,000,000.00 S 200,000,000.00 BODILY INJURY AND PROPERTY DAMAGE Exphation Date (Combined Sin& Lim 1 and Employers Liability Date 10/12 Each Occurrence Allgrellam S I - Woriters Each Aa !dent S Disease- Each Employee $ { Pagr Limit $ Policy Number Type of ineuranos Pellaieet[od EffeclWe Date Expiation 100,000.00 100,000 500,000.00 Limits of Liability (at beginning of p ► period) me CERTIFICATE OF INSURANCE IS ROTA CONTRACT OF WSiRANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMMO, EXTENDS OR ALTERS TIE COVERAGE APPROVED BY ANY POLICY OESCRMED HEREIN HERM Name and A ss of won Holder MIAMI SHORES YI l AGE M 33 DIWARTMENT 10060 NE 2ND AVE MIAMI SHORES ,FL 33138 Fax: 854 - 7624724 if any of the described policies are canceled before the expiradon date, State Fenn. eel by to mail a written notice to the certificate holder 30 days before mediation. If we fail to mail such notice, no ()Wagon or lability will be imposed on State Fann or its agents or represe+tatives. AGENT Tire GUY BRICKMAN Agent Nene Telephone Number (308) 8224921 031071/2 Dote Spas Cede SLr�p Agerdtada less APO coda 50 108390.10 03.08 1 PAIAMI-DADE coutrrY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MAK FL 33130 20 BuTt 2011 LOCAL BUSINESS TAX RECEIPT 20 --".7 MIAMI-DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2012 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A ART. 9 & 10 t4o.og,0.444, , (850) 487-3.395 N(5-T PWef -4r RENEWAL ' 11 ma. 02444 040544-0 3 ' FIRST-CLASS U.S. POSTAGE MIAMFL PERMIT No. 231 EETRW 12 on - ISE sl TAx 2/29/2011, 0234001000 DO NOT FORWARD RICKYS ELECTRIC COMPANY STEPHEN C RICCI 6886 NW 62 TERR PARKLAND FL 33067 ‘. 11131111311131111111111111'11.311141111%11 I a I Al 1 SEE OTHER SIDE 'caul es urt VII 0, It CA boxers ti) restaurants, and they..keep Florida's economy strong. Every day we work to improve the way we do business in order to serve you better; For information, about our servicesiplease log onto www.m~dalicensexere. There you can find more information about our divisions and the regulations that impact you, subscribe to department newsletters and team more about the Department's Initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you better so that you can serve your customers. Thank you for doing business in Florida,. and congratulations on your new license! DETACH HERE DATE BATCH N NI