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ELC-13-2601 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-203189 Permit Number: ELC-11-13-2601 Scheduled Inspection Date: December 12,2013 Permit Type: Electrical -Commercial Inspector: Devaney, Michael Inspection Type: Final Owner: LLC, MSVC Work Classification: Addition/Alteration Job Address:9488 NE 2 Avenue Miami Shores, FL 33138- Phone Number Parcel Number 1132060132780-88 Project: STARBUCKS Contractor: LIN R ROGERS ELECTRICAL CONTRACTORS INC Phone: (770)772-3400 Building Department Comments INSTALLATION OF 1 DEDICATED 120 VOLT, 20 AMP Infractio Passed comments RECEPTACLE FOR A 2 DOOR FREEZER INSPECTOR COMMENTS False Inspector Comments Passed E�f Failed C Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. December 11,2013 For Inspections please call: (305)762-4949 Page 11 of 30 ' Miami Shores Village � `�a NOV 1 2013 Building Department o �o 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 e Tel:(305)795.2204 Fax:(305)756.8972 INSPECTION'S PHONE NUMBER:(305)762.4949 FBC zo B D G Permit No. PERMIT APPLICATION Master Permit No. Permit Type: Electrical JOB ADDRESS: 9488 N.E. 2nd Ave City: Miami Shores County: Miami Dade 33138 Folio/Parcel#: 11-3206-013-2780 Is the Building Historically Designated:Yes NO Flood Zone: OWNER:Name(Fee Simple Titleholder):MSVC, LLC phi ; Ate;2310 Hollywood Blvd city. Hollywood State. Florida gip. 33020 Tenandi essee Name; Starbucks Corporation plme#; Email: ametz @starbucks.com CONTRACTOR:company Name: Lin R Rogers Electrical Contractors pie; 813-829-8154 Address. 2050 Marconi Drive Ste 200 City: Alpharetta Srate. GA Zip; 30005 Qualifier Name; Lin R Rogers phone#. 770-772-3400 State Certification or Registration#: EC0000740 Cerrificate of Competency#: Contact phone#; Email Amass: license @irogerselectric.com DESIGNER:Architect/Engineer: Phone#: value of Work for"Permit:$850.00 Square/Linear Footage of Work: Type of Work: DAddress • "` ©A1teration . . p C]Repair/Replace ODemolition Desaiiption of work: Installation of 1 dedicated 120 volt; 20 amp receptacle for a 2 door freezer. Submittal Fee$ Permit Fee$ A l CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Bond$ Notary$ TraininWEducation Fee$ Technology Fee$ Double Fee$ Structural Review$ TOTAL FEE NOW DUE$ Bonding eompany's Name{if applicable) Bonding Company's Address City State Tap 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 inspector occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not approv a reinspection fee will be charged Signatur Signature ,, � Owner or A:edged -- Contractor The foregoing instrument was ac before me this The foregoing instrument was ackno l�ed.�gal�before me this day of 20�,by � .. day of ! 20�by who is personally known to me or who has produced a fi who is rat known ne or who has produced ka AX-N. As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: r®®`® Ili1®®I®A Si Sign: Print Print a s AZ 10 to My Commission Expires: R My Commission Expires: 9N. .G ap X11 Pdit-01Mn� ® �; My Con. JW 30,2017 ,�j/�1.�G •�„ Commias •FF04i1ZS m v ° ®�B L�•Oyvy 3•s®e�� ®®'a APPROVED BY Plans Examiner ®®,i/y ct)I m ,® ®®/Si161111®� Structural Review Clerk (Revised 3/12/2012)(Revised 07 110/07)(Revi W 06/1012W9)(Revised 3/15/09) i 40 F oxam ebms to ~v s.mn mom "0" UL m "14 4 GVrIa oo �� JI�i494�Y "I ROGERS ELECTRIC° October 10,2013 Miami Shores Village 10050 N.E.2nd Avenue i Miami Shores, FL 33138 RE: Permit and Registration Authorization i Dear Permit and Inspection Dept: Please accept this letter as authorization for, �'� I ®►1 employee of Lin R.Rogers Electrical Contractors,Inc.to sign and submit all paperwork necessary to register,pull permits,and schedule inspections as needed in the Village of Miami Shores. Sincerely, Lin R.Rogers FL License#EC0000740 i Sworn and subscribed before me this-10 day of duo j leg ZIP 11 r ��GHELLE C �sAi C�;per i9 jP N • 4 � COUNT�lz� - . ... 1 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 s_4_ of��ga Congratulations! With this license you become one of the nearly one million , $1? `I°ME C}1? 00II Florldians licensed by the Department of Business and Professional Regulation. gta�B,gl UTI0N Our professionals and businesses range from architects to yacht brokers,from s. boxers to barbeque restaurants,and they keep Florida's economy strong. Of ZCt}00(f74Q ay�r 11820620� Every day we work to improve the way we do business in order to serve you better. `r'3 w For information about our services,please log onto www.myfloridalicense.com. CERTTFI I. NTRACT(�R; There you can find more Information about our divisions and the regulations that REFERS,` impact you,subscribe to department newsletters and loam more about the L L_it, R r CAS+nAC Department's initiatives. Our mission at the Department is:License Efiiclently,Regulate Fairly.We constantly strive to serve you better so that you can serve your customers..,,,.r ..z Thank you for doing business in Florida,and congratulations on your new license! 1s cER�rzirr> o '"'aer ctae �Foo�eios e; r�.989 ss �y#saEion datwi AIIi�:3t� .2014, '� L1ad8190i291 4- DETACH HERE AC# 6167234 STATE OF FLORIDA, DEPARTMENT OF:.#US NES PR FESSI RLGI7LATION �� pp� QQ ELECTRICAL (I"O�CTORS L.IGENSIRBOARD. S�V#L12061901295 I x 06 19 201'2 118206x201.` EC000d'� 0g " . _e W. . _ The ELECTRICA4 cbkT CTOR j Named be164 IS CERTIFI Under the pro4isibas of Chapte. Expiration 'datet AUG 31, 2014 n i ROGERS? LIN .A. LIN R ROGERS` TLECTRICA ;COl 2050 MARCONI DR 9TE 200 ALPHARETTA GA 30005 "-_�O,�y" k R3CK SCOTT: I= LAWSON 'GOVERNOR SECRETARY 0 . DISPLAY AS REdU1RED BYtAW �. _._... .._---- _ __.._-----------_.. _....... _ .._...... .... . .. .......... . ..._.._..._.._._._- BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954-8314000 VALID OCTOBER 1,2013 THROUGH SEPTEMBER 30,2014 Recei t#:181-3052 DBA:LIN R ROGERS ELECTRICAL Business Type: Business Name:CONTRACTORS INC yp (ELECTRICAL CONTRACTOR) Owner Name:LIN R ROGERS Business Opened:01/29/2007 Business Location:2050 MARCONI DR 200 State/County/CerVReg:EC0000740 OUT OF STATE Exemption Code: ; i Business Phone:770-772=3400 Rooms Seats Employees rMacftlnes Professlocals `4 I 4 i For Vending Business Only Number of Machines: Vending T pe: J 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 I 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 and/or 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 Receipt #04C-12-00003433 2050 MARCONI DR STE 200 Paid07/16/2013 27.00 ALPHARETTA, GA 30005 2013 . 2014 I _. LINRROG-01 JOCA CERTIFICATE OF LIABILITY INSURANCE 1 DATD/YYYY) 9/119/21912013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO'RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condifJons 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 endomement(s). PRODUCER (404)633-4321 NAME. Yates Insurance Agency PHONE MAX 2800 Century Parkway NE A/c No Ext: A/c No): Suite 300 ADADRESS: Atlanta,GA 30345 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:Travelers Indemnity Company 25658 INSURED Lin R.Rogers Electrical Contractors,Inc. INSURERB:Charter Oak Fire Insurance Company 25615 Rogers Electric Service Corporation INsuRmc:National Union Fire Ins Co Pittsburgh PA 19445 Rogers Electric Lighting Corporation INSURER D:Travelers Indemnity Company of America 25666 2050 Marconi Drive,S#200 INSURER E:Travelers Property Casualty Co of America 25674 Alpharetta,GA 30005 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL BR POLICY NUMBER MPM/DO/EFF MPOLICD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 A X COMMERCIAL GENERAL LIABILITY VTC2KCO5787B539 11112013 1/112014 PREMISES Ea occurrence $ 300,00 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 15,00 PERSONAL&ADV INJURY $ 2,000,00 GENERAL AGGREGATE $ 4,000,00 GEMLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,00 POLICY X PRO LOC $ AUTOMOBILE LIABILITY �MBBIINdEDISINGLE LIMIT $ 1,000,00 B X ANY AUTO CAP5787B540 111/2013 11112014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED (Par acd TfmDAMAGE $ X Hired Phy Dam $ X UMBRELLA LIAR I X OCCUR EACH OCCURRENCE $ 15,000,00 C EXCESS LIAS CLAIMS-MADE BE1SS05625 11112013 11112014 AGGREGATE $ 15,000,00 DED X RETENTION$ 10 000 $ WORKERS COMPENSATION X TWOCR S1 OTH- AND EMPLOYERS LIABILITY D ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N VTC2HUB8571C373 1/1/2013 1/1/2014 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? N1 N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If Yyes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 E Leased/Rented Equipment QTSS001041-715 111/2013 111/2014 Deductible:$1,000 500,00 E Installation/Job Site QT66001041-716 1MI2013 11112014 Temp/Transit$400,000 4,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) General Liability policy referenced above provides per aggregate limit as required by written contract Workers Compensation includes State of FL In 3A. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 9 pa ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Ave. Miami Shores,FL 33138- AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD DRIVER'S LICENSE '` NUMIER EXPIRES 09-28-2017 ROGERS,UNDY RAY 1005 BEDFORD GARDENS DR ALPHARETTA,GA 30022-6276 SEX BIRTHDATE ISSUE DATE COUNTY m 09-28-1957 08-20-2007 060 WEIGHT WEIGHT CSC FEE RESTRICTIONS. 5-08 185 7 100 30.00 ?tea CLASS ENDORSEMENTS TYPE 4 C REG I