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ELC-11-2278Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 1 l - 1(61` Inspection Number: INSP- 167520 Permit Number: ELC -12 -11 -2278 Scheduled Inspection Date: July 09, 2012 Inspector: Devaney, Michael Owner: , SHORES SQUARE INVESTMENTS Job Address: 9025 BISCAYNE Boulevard Miami Shores, FL 33138 -0000 Project <NONE> Contractor: OHMS ELECTRICAL CONTRACTOR Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060110051 -25 Phone: (954)974 -3840 Building Department Comments INSTALLATION OF A NEW ELECTRICAL DISTRIBUTION POWER AND LIGHTING SYSTEM Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments July 06, 2012 For Inspections please call: (305)762 -4949 Page 4 of 26 1[Ii1Q1111 l[ Carlos A. Gimenez, Mayor 4/11/2012 Issued Date: 4/6/2012 $ECE VEi MAY 1 L 2612 SHORE SQUARE PROPERTIES LLC 696 NE 125 ST MIAMI, FL 33161 RICARDO E. BERMUDEZ 8240 SW 35 TERR MIAMI, FL 33155 RE: Sewer System Treatment and Transmission Capacity Certification 2012- ALLOCATION -01242 Permitting, Environment and Regulatory A Affairs Environmental Services 11805 SW 26th Street, Ste. 124 Miami, Florida 33175 -2474 T 786- 315 -2800 F 786 -315- 2919 The Miami -Dade County Department of Environmental Resources Management (DERM) has received your application for approval of a sewer service: connection to serve the following project which is.n more specifically described in the attached project summary. Project Name: FIT 4 LIFE MEDICAL CENTER/ M2012005316 Project Location: 9025 BISCAYNE BL VD, MIAMI SHORES, FL 33138 Previous Use: 5007 SQ. FT. RETAIL Proposed Use: 5007 SQ. FT. MEDICAL OFFICE .P Flow: 500 GPD otu ated Flow. 1001 GPD IC " Allocat l Flow: 501 GPD Sewer Iity: UNINCORPORATED DADE.000NTY Rec:eiv' `p Pump Station: 30 - 0049 DERM as evaluated your request in accordance with the terms and conditions: set forth in Paragraph 16, C of the First Partial ,Consent Decfee (CASE NO. 93-1109 CIV- MORENO) between the United States of America and Miami-Dade County. DERM hereby certifies that adequate treatment and transmission capacity, as herein defiled, is available for the above described project. Furthermore, be advised that this approval does not constitute, Departmental approval for the proposed project. Additional reviews and approval may be required from sections having jurisdiction over specific'aspecta of this project. Also, be advised that the gallons per day (GPD) flow determination indicated herein are for sewer allocation purposes only (in compliance with Consent Decree requirements) and may not be representative of GPD flows used in, calculating connection: fees by the utility providing the service. Please be aware that this certification is subject to the terms and conditions set forth in the Sewer Service Connection Affidavit filed by the applicant, a copy of which is' hereby attached. Should you have any questions regarding this matter, please contact the Miami -Dade Permitting and Inspecting Center (MDPIC) (786) 315 -2800 or DERM Office of Plan Review Services, Downtown Office (305) 372 -6899. Sincerely, Lee N. Hefty Interim Director Dep t of Environmental Resources Management . . ./7-0°- Car Hernandez, P.E. Chief, Office of Plan. Review Services By: .13A 2 111 lE Owner's Name: SHORE SQUARE PROPERTIES LLC Owner's Address: 696 NE 125 ST MIAMI, FL 33161 EEOS Allocation Number: 2012- ALLOCATION -01242 Project: FIT 4 LIFE MEDICAL CENTER / M2012005316 Proposed Use: 5007 SQ. FT. MEDICAL OFFICE Pump Station: 30 -0049 Projected NAPOT: 4.83 2012 - ALLOCATION -01242 ler swzr ress HORE Page 2 of MIAMI "QA©E .COUNTY VERIFICATION FORM EXPIRES ONE YEAR FROM DATE ON FORM miamidade.gov ATLAS PAGE: E-8 INV#: Vg•tiV FORM #: 201130699 DATE: Water and Sewer PO Box 330316 • 3575 S. Lejeune Road Miami, Florida 33233 -0316 T 305 -665 -7471 NAME OF OWNER: "PROPERTY ADDRESS: PROPOSED USAGE / NO. OF UNITS: REPLACES: PREVIOUS USAGE / NO. OF UNITS: PROPERTY LEGAL: 'MEDICAL OFFICE IMPROVEMENT 10/25/2011 9025 BISCAYNE BLVD 5,003 SF MEDICAL OFFICE PER PLANS 7,350 SF MEDICAL OFFICE WITH 5 PHYSICIANS PAID ON INVOICE # 121026 6 53 42 ASBURY PARIS PB 4-110 BEG 30FTW OF SE COR LOT 5 RUN W272.08FT N177FT W280.97FT TO E RIW/L BISC BLVD FOLIO NUMBER: L 11- 3208-011 -0051 GALLONS PER DAY INCREASE: ( -249 ,PREVIOUS FLOW: L 1,250 PREVIOUS SQUARE FOOTAGE: 7,350 ; ❑ NEW CONSTRUCTION PROPOSED FLOW: 1,001 PROPOSED SQUARE FOOTAGE: 3 ® INTERIOR RENOVATION THIS IS TO CERTIFY THAT THE MIAMI -DADE WATER AND SEWER DEPARTMENT DOES HAVE A(N)12 INCH WATER MAIN ABUTTING THE SUBJECT LEGALLY DESCRIBED PROPERTY. WE ARE WILLING TO SERVE THE SUBJECT PROPERTY, (OR, IF %WILL HAVE", UPON PROPER CONVEYANCE AND PLACEMENT INTO SERVICE OF WATER FACILITIES BY THE DEVELOPER UNDER AGREEMENT WITH THE DEPARTMENT, (AGREEMENT ID # NIA) SUBJECT TO PROHIBITIONS OR RESTRICTIONS OF GOVERNMENTAL AGENCIES HAVING JURISDICTION OVER MATTERS OF WATER SUPPLY OR WITHDRAWAL. Gonzalo Garda Jr. - New Business Representative SIGNATU- OF RE J: ES TIVE AUTHORIZED BY INESS C NT 1F CONNECTION TO 12" MAINS IN RISC BL AND /OR NE 90 ST IS NEEDED EITHER FOR (SERVICE, FL OR EXTENSION, COLLECT APPLICABLE WM CCC, MFS 11-9-2009 VF $150 I 1 PLANS REVIEW COMMENTS: CRITERIA: E4 J THIS IS TO CERTIFY THAT THE MIAMI -DADE WATER AND SEWER DEPARTMENT DOES HAVE A(N) 8_ INCH GRAVITY SEWER MAIN ABUTTING THE SUBJECT LEGALLY DESCRIBED PROPERTY. WE ARE WILLING TO SERVE THE SUBJECT PROPERTY, (OR, IF "WILL HAVE ", UPON PROPER CONVEYANCE AND PLACEMENT INTO SERVICE OF SEWER SEWER FACILITIES BY THE DEVELOPER UNDER AGREEMENT WITH THE DEPARTMENT, (AGREEMENT ID # N/A ). SUBJECT TO PROHIBITIONS OR RESTRICTIONS OF GOVERNMENTAL AGENCIES HAVING JURISDICTION OVER MATTERS OF SEWAGE DISPOSAL. FURTHERMORE, APPROVAL OF ALL SEWAGE FLOWS INTO THE DEPARTMENTS SYSTEM MUST BE OBTAINED FROM D.E.R.M. THE ANTICIPATED DAILY WATER AND/OR SEWAGE FLOW FOR THIS PROJECT WILL BE: TWO HUNDRED F! NINE ( -2491 GALLONS PER DAY INCREASE. Gonzalo Garcia Jr. - New Business Representative SIGNAT E OF) -'- ES ` ATIVE AUTHORIZED BY BUSINESS OMM S: D.E.R.M. SEWER ALLOCATION LETTER DATED: 2010-ALLOCATION-02480 PER CG STILL 'ACTIVE PLANS REVIEW COMMENTS: CONTACT NAME: CONTACT PHONE: AUTHORIZED BY: _ a • is 1 -1 r groi . Printed On: 11/2/2011 NB: Gonzalo Garcia Jr. 10:43:03 AM PR: 1/--/b7 OP ID: CJ .. '..au' CERTIFICATE OF LIABILITY INSURANCE DATE 01 /17D/YYYY) 01117/12 HOLDER. THIS BY THE POLICIES AUTHORIZED THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poiicy(tes) 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 Ileu of such endorsement(s). PRODUCER 407- 660 -8282 Brown & Brown of Florida, Inc. 2600 Lake Lucien Dr. Ste. 330 407- 660 -2012 Maltland, FL 32751 -7/134 Jeffrey R. Seidl, CIC, CRM ACT NAME: (NC. No. ), FAX No): E -MAIL ADDRESS: PRODUCER T &G•C0-1 CUSTOMER ID $: INSURER(S) AFFORDING COVERAGE NAIC INSURED T & G Corporation dba T & G Constructors 8623 Commodity Circle Orlando, FL 32819 CAVFRA GFC INSURER A : Ameris u re Insurance Company S 19488 INSURER B :Amerlsure Mutual Insurance Co 23396 INSURER c: CPP2003738 PER GL FORM CG0001 INSURER D : 10/01/12 INSURER E : $ INSURERF: PRD EM SEBO(EaEo irrence) THIS INDICATED. CERTIFICATE EXCLUSIONS INSR ___ __" NtVI,IUN NUMBER: IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 11TH RESPECT TO WHICH THIS MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFT JMMIDDMYYY) POUCY EXP (MMIDD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY 1 X 1 OCCUR LAB X CPP2003738 PER GL FORM CG0001 10/01/11 10/01/12 EACH OCCURRENCE $ 1,000,000 PRD EM SEBO(EaEo irrence) $ 50,000 CLAIMS MADE MED EXP (My one canon) $ 6,000 X GEML 7 CONTRACTUAL PERSONAL & ADV INJURY $ 1,000,000 XCU INCLUDED GENERAL AGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER POLICY n IJECT H LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA2003767 10/01/11 10/01/12 COMBINED SINGLE $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per aetlderrt) $ PROPERTY DAMAGE (Per sodden) $ $ $ B X X UMBRELLA LIAB EXCESSLIAB X OCCUR CLAIMS MADE CU2003704 10/01/11 10/01/12 EACH OCCURRENCE $ 6,000,000 AGGREGATE $ 6,000,000 X DEDUCneLE RETENTION $ NONE Excess of GL,AL,WC $ A WORKERS AND ANY (OFFICER/MEMBER (f ppestle DESLrRIPTION COMPENSATION EMPLOYERS' LIABILITY /" below N I A WC2003986 10/01/11 10/10/12 I WCSTATU- IOTH- X TORY UMITS ER PROPRIErOREXCLU JBICECUnvEY EXCLUDED? a NH) OF OPERATIONS E.L EACH ACCIDENT $ 500,000 E L. DISEASE - EA EMPLOYEE $ 500,000 E.L DISEASE - POUCY UMR $ 500,000 B B Rent/Leased ACV Equip & Install DED $1000 CPP2003738 10/01/11 10/01/12 Leased Install 105,000 250,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, IT more space Is required) Village of Miami Shores Is granted additional insured status by the General Liability policy with regardto the operations of the named Insured when required by written contract or agreement. CFRTIFIPATC writ nro VILL100 Village of Miami Shores 10050 NE 2nd Ave Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2009109) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1/- /6/6 SERVICE SCHEDULE QUALITY Florida State Construction Licenses • , .• • DATE , • • bATC51 tgAZIgEMIULAR2w3MMENNERENENSEnam. MI& FL Hoofing License - 3 ....,.- ..r. ...1 . , ....<9 ... ..-.I. - .......,.......1 . g. ,.<i. $.t 4..,... . .1.2.5..T.w.n.ai" 1i-"""'N""r":,eY '"c! '4i "'• ' C"" "O'''"U'W". a"i z... r".-1 ." d ":N 1• 7. ,.4 I . !Tr'ty%', • 1nOt'1 k"....G o L43BTAG O3W m T)y -1•".5fr.' priftmfrItto.k0A0.01 .i.,•• - (-, <424: „3 i<-: , ',,,, 4. 'THIS CS.1101AGILL-pc*Crr. PAY s.1.4.4tWM:959.,_, 51$11,20.42 49444St-1 OUsItNESSNAlitsitaVATION. T N G CORP at4a NW Si .ST' 33164. DORAL °1181. G CORP '&04.1suRfnitta iikNERAL BUILDING toNTIIAO-NR, ofig tibilidt FORWARD! :CONI* jaCARDOT Matit****E0. Nit A141- 471 .P.gfAi. .61101104:1411.talitratimi10104444M: • v. 7. . • • NOTICE OF COMMENCEMENT A RECORDED COPY MUST BE POSTED ON THE JOB SITE AT TIME OF RRST INSPECTION 1 111111111111111111111 1111111111 1111111111111 PERMIT NO. TAX FOLIO NO. t' - 320 6 U i 1 00s7 STATE OF FLORIDA: COUNTY OF MIAMI -DADE: THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. CFI 201 1R066 1 16 DR Bk 27845 F's 45i �4 0 (1139 ) RECORDED 10/03/2011 013/2011 12 :04 :03 HARVEY RUVII4r CLERK OF COURT MIAi1I -DADE COUNTY, FLORIDA LAST PAGE CIO above reserved for use of recording office 1. Legal description of property and street/address: -1 O 2- 5 - 9 b'? 1 (S G ,s5 33 13 g 2. Description of improvement: 3. Owner(s) name and address: A-(L• (nt VisS-on L.G Interest in property: Name and address of fee simple titleholder. 4. Contractor's name, address and phone number: g.UnA A G — Co a s- rR -Uc.T i o 1.1 �-`t S'"s k o S 7' SSb 13ta Aft t,& t -, 33t'f , AA t 141.■n I 4►_ 33 I 5--s- 5. Surety: (Payment bond required by owner from contractor, if any) Name, address and phone number: Amount of bond $ 6. Lender's name and address: 7. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes, Name, address and phone number: 8. In addition to himself, Owners designates the following person(s) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name, address and phone number: 9. Expiration date of this Notice of Commencement: F913 - o 11- (the expiration date is 1 year from the date of recording unless a different date is specified) WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YoU'+ NOTICE OF MENCEMENT. Signature(s) of Own Prepared By Print Name _ Title /Office STATE OF FLORIDA orized Officer /Director /Partner /Manager Prepared By ... A N S RA) wJ131s - 12./.4.4 b101Z4AJD Uzi Print Name Title/Office 0 to 02- S AG,es wl T 4240 S.+ 31- "fe1 - COUNTY OF MIAMI -DADE C� The foregoing instrument was acknowledged before me this ay of B s Individually, or ❑ as ersonally known, or ❑ produced the following type of ide Signature of Notary Public: Print Name: (SEAL) VERIFICATION PURSUANT TO SECTION 92.525, FLORIDA STATUTES Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in ' e true, to the best of my knowledge and belief. M-f r4.'► i A- Sign;e(s) of Owner(s),or s)'s Authorized Officer/Director /Partner /Manager who signed above: Miami Shores Viiiage Building Department RECEIPT PERMIT MCC) ) I 1tQc1 DATE: 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 ❑ Contractor ❑ Owner ❑ Architect Pick p 2 sets of plans an Address: - From the building department on this date in order to have corrections done to plans And /or get County stamps. I understand that the plans need to be brought back to Miami Shores Village Building Depart , to continue permitting process. Acknowledged by: PERMIT CLERK INITIAL RESUBMITTED DATE: PERMIT CLERK INITIAL: Permit tom,.. 111-1693 Job Name: September 22., 2011 Miami Shores Village Budding Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Building Critique Sheet 1) tiVtpe approval from Miami Dade County. Fire Dept.s �Q 6-vi approval from Miami Dade County DERM. vide approval from HRS /DOH/ /Pro u cde all permit applications (MEP) prior to any further reviews. rret.tions must be made for Plumbing, Electrical, Zoning. The plans are identified as a level 2 alteration but are atso a change of use. A to B. P�rovtde.wind Toad design criteria on plans. 8j ro ide design wind loads for each altered opening with calculations. Provi4e.product approvals for all new and altered ope ings and storefront. The PA must { rtaie+wed and signed' approved by the designer of cord. Adtca1 on the plans the use /occupancy of adjacent tenants. The door schedule uses tag #33 twice and does not show #34. 12) Done/Is/0n and show all accessible features for the private.bath or show that it is dapjaple and in compliance with private bath exemption. 11a4iine filled cells in the infill detail. Minimum 1 #5 on each side from foundation to be awi. The new door detail specifies filled cells to beam but only show them to new lintel. )poor does not show the elevation of the exterior grade in relation to finish floor. Page 1 of 1 Plan revieto tssert complete, when all items above are corrected, we will do a complete pia review. If any skeert ale 'Voided, remove them from the plans and replace with new revised sheets and include one set-of voided sheets in the re- submittal drawings. Norman ' CBO 305-795- \ o -- 't rz,(telitic4c, Permit No: 11 -1693 Job Name: December 14, 2011 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Page 1 of 1 Building Critique Sheet 2nd 1) Provide approval from Miami Dade County Fire Dept. Previously approved plans have been revised and plans approved by fire voided. Plan review is not complete, when all items above are corrected, we will do a complete plan review. If any sheets are voided, remove them from the plans and replace with new revised sheets and include one set of voided sheets in the re- submittal drawings. Norman Bruhn CBO 305 - 795 -2204