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ELC-11-2053Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 166315 Permit Number: ELC -11 -11 -2053 1 Inspection Date: September 26, 2012 Inspector: Devaney, Michael Owner: Job Address: 9899 NE 2 Avenue Miami Shores, FL Project <NONE> Contractor: LIN R ROGERS ELECTRICAL CONTRACTORS INC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number Parcel Number 1132060134360 Phone: (770)772 -3400 Building Department Comments ADDITION OF TWO WALL PACK FIXTURES Passed Er Inspector Comments o ee l 7--- - ✓ 2 , Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled re- inspection fee is paid. until For Inspections please call: (305)762 -4949 April 09, 2013 Page 1 of 1 itkotHli geApice 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 V D NOV 0 4 2011 Permit No. FLO L 2Cd Master Permit No. Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): Robert Richardson Phone#: 804 -697 -7491 Address:1021 E. Cary Street 8th Floor City: Richmond State: VA zip: 23219 -4058 Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: 9899 NE 2nd Ave Miami Shores 33138 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: 11- 3206 - 013 -4360 Is the Building Historically Designated: Yes NO Flood Zone: (3I9 —,3 % 5429 CONTRACTOR: Company Name: Lin R. Rogers Electrical Contractors Phone #: 770 -772 -3400 Address: 2050 Marconi Drive Suite 200 City: Alpharetta State: GA Zip: 30005 Qualifier Name: Lin R. Rogers Phone#: State Certification or Registration #: EC00000740 Certificate of Competency #: Contact Phone#: 770- 772 -7958 Email Address: myost@lrogerselectric.com DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 3,356.07 Square/Linear Footage of Work: Type of Work: Address UAlteration ❑New ❑Repair/Replace Description of Work: addition of two wall pack fixtures ❑Demolition * * *** ** *** * ** *** *+x:n **** *** * * *+x** ** ** Fees** ***** ******* *** * * * * **:x *********:x** ** ***** Submittal Fee $S3 Permit Fee $ /.....4.---e0 se0C, CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Trai:ning/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 1 ID. • • 4 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 ELECTRICAL 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 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 \"-1 Signature f eeK Owner or Agent Contractor The foregoing instrument was acknowledged before me this The The fore sing instrument was acknowledged before me this/ day ofOffibelL. ,20 11 ,by S(,_ , day o 0e ',by who is6rsonally knos m)o me or who has produced wh me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: WWAALy Vtiai My Commission Expires: )0/31/741-3 „\1` 1 l l/ 1/, �Y S / `r. Sign:, Print: NOTARY PUBLI�C��y�oQ�BOO reo�g OF _ a OW e /en' % Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487 -1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399 -0783 ROGERS, LIN R' LIN R ROGERS ELECTRICAL CONTRACTORS INC 2050 MARCONI DR STE 200 ALPHARETTA GA 30005 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and Professional Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque 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 services, please log onto www.myfloridalicense.com. 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 IMMO- BA CH i''JIi.jE UNRROG -01 AUCH ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE 0 TYPE OF INSURANCE PRODUCER (404) 633 -4321 Insurance Agency 4 Yates tes Insurance Park East, NE Suite 200 Atlanta, GA 30329 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Lin R. Rogers Electrical Contractors, Inc. Rogers Electric Service Corporation Rogers Electric Lighting Corporation 2050 Marconi Drive, S# 200 Alpharetta, GA 30005 INSURER A: Travelers Indemnity Company 25658 INSURER B: Travelers Property Casualty Co of Americ25674 VT22KC05787B539 INSURER C: National Union Fire Ins Co Pittsburgh PA 19445 INSURER D: Travelers Indemnity Company of America25658 $ 1,000,000 INSURER E: DAMAGETO RENTED PREMISES (Ea occurence) COVERAGES THE POUCIES 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDmONS OF SUCH POLICIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD1 INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDDIYY) POLICY EXPIRATION DATE (MMIDD/YY) LIMITS A GENERAL UABILITY COMMERCIAL GENERAL UABILITY VT22KC05787B539 1/1/2011 1/1/2012 EACH OCCURRENCE $ 1,000,000 X DAMAGETO RENTED PREMISES (Ea occurence) $ 300,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000 —1 POLICY X PFQ LOC B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS Hired Physical Damage VTOCAP5787B540 1/1/2011 1/1/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) X BODILY INJURY (Per accident) X X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGG $ C EXCESS/UMBRELLA UABILITY BE26159418 1/1/2011 1/1/2012 EACH OCCURRENCE $ 15,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 15,000,000 DEDUCTIBLE REItNTION $ 10,000 $ $ X $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Ky� describe under SPEGrIAL PROVISIONS below VTC2HUB8571 C373 1/1/2011 1/1/2012 X ORY LIMITS oat E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 B OTHER Leased/Rented Equipment QT6600104L715 1/1/2011 1/1/2012 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS f VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS General Liability policy referenced above provides per project aggregate limit as required by written contract. Workers Compensation includes State of FL in 3A. ELLATION City of Miami Shores 10050 Northeast 2nd Avenue Miami Shores, FL 33138- SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE f> -/ ACORD 25 (2001/08) BROWARD COUNTY-LOCAL-BUSINESS TAX -REC 1P 115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301 -1895 — 954 -831 -4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 20x2 DBA: Receipt #:181-3052 Business Name: LIN R ROGERS ELECTRICAL ELECTRICAL /ALARMS /CONTRA Type: CONTRACTORS INC (ELECTRICAL CONTRACTOR) Owner Name: LIN R ROGERS Business Opened:oi /29/2007 Business Location: 2050 MARCONI DR 200 State/County /Cert!Reg :EC0000740 OUT OF STATE Exemption Code:NONEXEMPT Business Phone: 770- 772 -3400 Rooms Seats- Employees 4 Machines : Professionals For Vending Business Only Number of Machines: vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County andtor Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: LIN R ROGERS 2050 MARCONI DR STE 200 ALPHARETTA, GA 30005 Receipt #034 +0.0 - 00002394 Paid 07./26/20.11 27.00 2011 - 2012 ROGERS ELECTRIC® Wednesday, October 26, 2011 Miami Shores Village Building Department 10050 NE 2nd Avenue Miami Shores, Florida 33138 Phone: (305) 795 -2204 To Whom It May Concern: Please accept this letter as authorization for, fi cm;6 mployee of Lin R. Rogers Electrical Contractors Inc. to sign and submit all paperwork necessary to register, pull and schedule inspections as needed in Miami Shores Village. If you have any questions, please do not hesitate to call me at 770 - 772- 7958(office). Sincerely, Lin R. Rogers Chairman Sworn and subscribed before me this d--1 day of e , d9 1 . Notary Publi•; Dawson County, Georgie My Commi- on Expires July 24, 2012 2050 Marconi Drive, Suite 200 ® Alpharetta, GA 30005 ® Phone 770.772.3400 Fax 866.592.9161 ® www.lrogerselectric.com LIN R. ROGERS ELECTRICAL CONTRACTORS, INC. CHECK REQUEST FORM PAYABLE TO: ??2'a,'Y)O „51-7(Af-,) ADDRESS: REASON: Permit Application Fee Wells Fargo 3,gd AMOUNT: REQUESTED BY: JOB NO.: B117741 VENDOR NO.: GL #: 0i" Greg Palmer //09/6 -/J 506 ENTERED BY: DUE DATE: DATE: 11 Fif/ dk / wok% �ffvie- 1• $€ rf APPROVED BY. COST CODE CHECK DELIVERY INSTRUCTIONS MAIL CHECK TO VENDOR DELIVER CHECK TO MAIL CHECK TO OTHER 002 Misty Yost NOTICE OF COMMENCEMENT A RECTEIDEO COPY NOIST HE P0580 011 TN JOB STEM' TIME OF ROST INSPECTEIN pERNT Niaoal 44X/30U0 b Aro OF FLORIDA: COUNTY OF MAW-DAD E No.11-3206-013-4360 THE UNDERSIGNED hereby gives notice that Improvements will be made to certain real property, and kr socordance with chapter 713, Florida Statutes, the following information is provided In this Notice of Cornmermement 1 111111111111111111111113111111111111111111 CFN 2011R07 445 -3 OR St; 27884 Pg 2211; (1p9 ) RECORDED 11/04/2011 11:48W HARVEY RUVIlly CLERK OF COURT MIAMTDADE COUNTY. FLORIDA LAST PAGE Space above reserved for use of recording office 1. Legal description of property and street/address; 9899 NE 2nd Ave Miami Shores 33138 1 1-1706-01 1-416D 2. Description of improvement Installation of earldne lot %Wine 3,, owner(e) name and edam*: S.,*rt Iticluadson0021 E. Cary Street 8th Floor Richmond VA 23219-4058 Interest in property: \ r3 4.44c e...er," infiPet16*- Name and address of fee simple titleholder: 4. Contractor's name, address and phone number Lin R. Rogers Electrical Contractors: 2050 Marconi Drive Suite 200 Alpharetta GA phone: 770-772-3400 30005 E. Surety: (Payment bond required b):..,rii3r2p /41 Amount of bond $ Name, address and Monad:mbar. 6. Lender's name and • fr 7. Persons within the State of Florida des ruled by Owner upon,whom notices or other documents may be served as provided by Section 713.13(1MT., Florida Statutes, j- • Name and on1numbe .b4i.)" ) ai r 0 q 1 N.. .40 . . EsUrallAs .vre...irserare 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: if\ O. Expiation date of this Notice of Commencement expiration date is 1 year horn the date of recording unless a different date is specified) WASINIM3 TO SWAIM 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 STARITES, AND CAN RESULT IN YOUR PAYING TWICE FOR WIPROVEMENTS TO YOUR PROPERTY. A NOTICE OF CCwAIDIC.EMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTX1N. IF YOU INTEND TO OBTAIN RNANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. Signattue(s) of ..X.r_r. Prepared By Print Name ity-1 Titlefce -STATE-OF-FL-GRIDA l-E ) -COUNP(-9F-MIAMI-DADE kYIA. Of" 1 The Ging Metro acknowledged before me this Sexi day of Ckait_eA C —AI A-4 ttAM, — ArOIMMVAVIT Officer v., or/Partner/Manager Prepared By Print Name Title/Office bto-144:0%.101f1" BY ID Individually, or IA Personally known, la produced the following type of Signature of Notary Public Print Namm PEAL) ItglifflrefflatLEYBSUAKLICLEEGM122,fi25.. Under penalties of perfury, I declare that I have read the foregoing and that the facts stated In it are true, to the best of my knowledge and belief. Sigmam*0 /Manager who signed above: BY IZIJII4SPASIS3a10 BY STATEOFFLORIDA,C01,04TYOF DADE IHEREBYCERTIFYthetthiside -awaint, orig,naifiiodOdndiploon *of of , A 020 WITNESS my hand and COW Seat HARVEY ftliVIN, C . of * and County Owl* -/.-"207/ D.C. BY '" 4. OF • Af•.„., • •••••,.. • * o A 1. Aril"' A87‘41.-- e•OZ "tIalfsbuo 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 Permit Type: Electrical JOB ADDRESS: 9899 NE 2nd Avenue FBC 20 Permit No. ELC -11 -1 -2053 SEP 1 252 Master Permit No. City: Miami Shores Folio/Parcel #: 11- 3206 -013 -4360 Is the Building Historically Designated: Yes County: Miami Dade Zip: 33138 NO Flood Zone: OWNER: Name (Fee Simple Titleholder): Robert Richardson Phone#: 804- 679 -7491 Address: 1021 East Cary Street 8th Floor City: Richmond State: Virginia Zip: 23219 -4058 Tenant/Lessee Name: Phone #: Email: roberrichardson @wellsfargo.com CONTRACTOR: Company Name: Lin R. Rogers Electrical Contractors Phone #: 770 - 772 -3400 Address: 2050 Marconi Drive Suite 200 City: Alpharretta Qualifier Name: Lin R. Rogers State Certification or Registration #: EC0000740 Certificate of Competency #: Contact Phone #: 770- 772 -3400 Email Address: gpalmer @lrogerselectric.com DESIGNER: Architect/Engineer: Phone#: State: GA Zip: 30005 Phone#: 770- 772 -3400 Value of Work for this Permit: $ 3,356.07 Square/Linear Footage of Work: Type of Work: UAddress UAlteration Description of Work: Addition of two Wall Pack Fixtures ONew ORepair/Replace ODemolition ***** *** ************ ***********:n**:x*** Fees*: x*********** **: x* ****** ***** **+x*** ** *** ** * ** Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ CCF $ CO /CC $ DBPR $ Bond $ Technology Fee $ TOTAL FEE NOW DUE $ 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 ELECTRICAL 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 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 ee will be charged. Signature Owner or Agent tt,J/ The foregoing instrument was acknowledged before me this to nt day of 3 +tteL, 2011_, by a beAt lam'` axitert , who is person to me or who has produced As identification and who di; t1,oath. I NOTARY PUBLIC: Sign: Print: My Commission Expires: /ts3/ /!3 aahd ..11 Bq% 4 ••'liar •• we PUBLIC t 11, REG if COMMISSION 103112013 •.•.4 ....•eeQ -'.• Contracto The fore oing instrument was acknowledged before me this 427 day of _ < _ _ , 20 ,�, by tin . who is perso allyimo to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Wig My Commission Expires: + a �O' A. , m k la -n . D• • I i/_ /l= ****. x*. xx�x. x�. x�xx�************** x��n�xx�* x�x�x�** 4!**************** �n.x�x****x�x� **** * * * **** * * *x.. *** 0 � *sviatr • ••...a•• '/ • •i1 • CQIIMTY a APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) ;1%0 Clerk Clerk