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ELC-14-117Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 210255 Scheduled Inspection Date: April 16, 2014 Inspector: Devaney, Michael Owner: LLC, MSVC Job Address: 9488 NE 2 Avenue Miami Shores, FL 33138- Project: STARBUCKS Contractor: M ELLIS ELECTRICAL INC Building Department Comments INSTALL/ REPLACE 20AMP GENERAL PURPOSE CIRCUIT - starbucks Permit Number: ELC -1 -14 -117 Permit Type: Electrical - Commercial Inspection Type: RWigh Work Classification: Addition /Alteration Phone Number Parcel Number 1132060132780 INSPECTOR COMMENTS False Phone: (352)457 -5629 Inspector Comments Passed CREATED AS REINSPECTION FOR INSP- 210099. Need to meet the electricion on the i b site. Failed Correction ❑ Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. April 15, 2014 For Inspections please call: (305)762 -4949 Page 22 of 32 Miami Shores Village y Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 �1 INSPECTION'S PHONE NUMBER: (305) 762.4949 FBC 20 BUILDING PERMIT APPLICATION Permit Type: Electrical JOB ADDRESS: 9488 NE 2ND AVENUE JAN 2:4 7014 Permit No. / / Master Permit No. � < r / �� City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel #: 11- 3206 - 013 -2780 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): MSVC LLC Phone#: A,mrP-,. 2310 HOLLYWOOD BLVD City: HOLLYWOOD Tenant/Lessee Name: Email: State: FL Zip: 33020 CONTRACTOR: Company Name: E ELLIS ELECTRICAL Phone#: 352.457.5629 Address: 4234 S BLUFF LAKE ROAD City: MASOCTTE State: FL Zip: 34753 Qualifier Name: MICHAEL E ELLIS Phone#: 352.400.5635 State Certification or Registration #: EC 13003559 Certificate of Competency #: Contact Phone#: 800.517.6484 Email Address: richburg @uspermit.net DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 800.00 Square/Linear Footage of Work: Type of Work: ❑Address LIAlteration ❑New ORepair/Replace ODemolition Description of Work: INSTALUREPLACE 20AMP GENERAL PURPOSE CIRCUIT ** * * * * ** * * * * ** * * * ** * * * ** ** Fees**** ********** ** * **� *� *�� *�a� * *� * *:x *� * *� *� *� Submittal Fee $ Permit Fee $ f �` r UU CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ L f -A - 1914111 ' Bd *bg 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 fee will be charged. Signature �! � Signature iAsV � V �' t PAMWni� or►Ag nt – Contractor The foregoing instrument was owledged bef ey a thisa day of 21014 1 b , who is personally known to me or who has produced ut ol* As identification and who did take an oath. NOTARY PUBLIC: My Commis o OANYAMA OW ROWRO NO" PuM e - NO of Fto W 3 s MY Comm. Expirea Jul 30, 2017 COMMIsSIN # FF 041125 APPROVED BY The foregoing instrument was acknowledged before me this zoTH day of JANUARY 20 —, by MICHAEL E ELLIS who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: X\ i W Q t,& c Print: HARRIET E BEACH MY COMMISSION # E:E:223174 ham' EXPIRES Au �,�'�� gust O7, 2016 f/f IV Plans Examiner V, aOl1. Zoning Structural Review Clerk (Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10 /2009)(Revised 3/15/09) {'M�ilLcictieGiiil�tilu 1/c o :y v k y 1;d1ni :y r_ �RtJ�11�aR6� 1 C1{74 i 4 AC # STATEE: OF FLORIDA DEPARTYlENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD � �iE(�#L3208140246 �it;�il<�,t0M ILICEN SE NBR 08 14 20121128038557 EC13003559 Additional Business Qualif The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions Of Chapter 489 FS. Expiration date: AUG 31, 2014 ELLIS, MICHAEL E M ELLIS ELECTRICAL INC 4234 S. BLUFF LAKE RD. MASCOTTE FL 34753 RICK SCOTT GOVERNOR KEN LAWSON _DISPLAY AS REQUIRED BY LAW SECRETARY SIGNATURE f E71 M - •:.i.'�3(Gi:;7Rt0:." :- »7":Jic tar:r�AC;�t.;: a STATE OF FLORIDA AC,* r� DEPARTI%MNT OF BUSINES S'Ait)D PROFESSIONAL REGULAT A EC13003559 08/14/12 128038557 r, CERTIFIED ELECTRICAL CONTRACTOR CSTR +CTOR R ELLS EL IE CAL INC 1 IS CSR iI`ZEb un6er the provisions of Ch.489 PS 8xpizatlea Sato. AUG 31, 201$ L12 08 14 02 461 BOB MWEE LAKE COUNTY TAX COLLECTOF EMPLOYEES I TYPE OF CONTRACTING BUSINESS BUSINESS M ELLIS ELECTRICAL INC 4234 S BLUFF LAKE RD MICHAEL E ELLIS 4234 S BLUFF LAKE RD MASCOTTE, FL 34753 2013 / 2014 LAKE COUNTY BUSINESS TAX RECEIPT STATE OF FLORIDA F Mu ACCT NO, 90640 RECEIPT NO. 8760018676 EXPIRES SEPTEMBER 30, 2( ORIGINAL TAX PENALTY TRANSFER FEE AMOUNT PAID TOTAL DUE Receipt *2013-0009972 Paid 07/13/2013 30.00 30.00 0.00 0.00 30.00 $0.00 BOB MCKEE 2013 2014 ACCT NO-., .90640 LAKE COUNTY TAX. COLLECTOR: LAKE COUNTYBUSINESS TAX RECEIPT RECEIPT NO-8760018676 STATE OF FLORIDA. . SEPTEMBER 30, 2014 TYPE OF CONTRACTING BUSINESS BUSINESS M ELLIS ELECTRICAL INC . . . . . . . . ORIGINAL TAX 30.00 4234 S BLUFF LAKE RD PENALTY. 0.00 TRANSFER FEE 0.00 MICHAEL E ELLIS AMOUNT PAID 30.00 S, BLUFF LAKE RD MASCOTTE, FL 34753 TOTAL DUE $0.00 Receipt #2013-0009922 PAiri 07/112/701 1 'zn nn /.�.� CERTIFICATE OF LIABILITY INSURANCE DAO 117/144 I PRODUCER Great Florida Insurance 1326 West North Blvd #1 Leesburg, FL 34748 Phone (352) 365 -1222 Fax (352) 365 -6135 CITY OF MIAMI SHORES BLDG DEPT. 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 M ELLIS ELECTRICAL, INC MICHAEL E. ELLIS 4234 S BLUFF LAKE RD MASCOTTE, FL 34753 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. INSURER A: CYPRESS PROPERTY & CASUALTY INSURER B: VICTORIA INSURANCE BRAD BURLEY INSURER C: FIRST COMP INSURER D: INSURER E: COVERAGES INSURER F: THE POLICIES OF INSURANCE LISTED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR NSRD f 8R TYPE OF INSURANCE POLICY NUMBER POLICY DATE D EXPIRATION LIMITS A ❑/ GENERAL LIABILITY [* COMMERCIAL GENERAL LIABILITY 1:1 El MADE � OCCUR ❑ GFL 1018035 06/11/13 06 /11/14 EACH OCCURRENCE 1,000,000 DAMAGE PREMISES Ea oocure� 100,000 MED EXP (Any one person) 5,000 PERSONAL & ADV INJURY 1,000,000 ❑ GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: [] POLICY ❑ PROJECT ❑ LOC PRODUCTS - COMP /OP AGG 2,000,000 B Vq, AUTOMOBILE LIABILITY ❑ ANY AUTO ❑ ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS nV NON OWNED AUTOS ❑ 9582321 04/26/13 04 /26/14 COMBINED SINGLE LIMIT (Ea accident) 1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) ❑ GARAGE LIABILITY ❑ ANY AUTO ❑ AUTO ONLY - EA ACCIDENT OTHER THAN EA ACC AUTO ONLY: AGG EXCESSIUMBRELLA LIABILITY ❑ OCCUR F CLAIMS MADE ❑ DEDUCTIBLE [_] RETENTION $ EACH OCCURRENCE AGGREGATE C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? Y If yes, describe under SPECIAL PROVISIONS below MWC0011559 -02 09/23/13 09/23/14 ❑ WC STATU- ❑ OTH- T RY LI tT R E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYEE 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS MIKE ELLIS EC13003559 CERTIFICATE HOLDER CANCELLATION ACORD 25 (200110$) RF © ACORD CORPORATION 1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL CITY OF MIAMI SHORES BLDG DEPT. 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO 10050 NE 2ND AVE THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY MIAMI SHORES, FL 33138 OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE BRAD BURLEY ACORD 25 (200110$) RF © ACORD CORPORATION 1988 -_ ' - - JAN � 4 �2p14 L T Y; EXISTING WARMING CADDY TO BE RELOCATED REMOVE EXISTING NGC OVEN �} I i L z CITY LEGEND_ EXISTING ITEMS TO REMAIN NEW ITEMS — RELOCATED ITEMS - REMOVED ITEMS STORAGE RACK COUNT DESCRIPTION EXISTING PROPOSED w em T_ SIMPLE 0 O W UJ Q u- UJ C) Z � � W Yzf V c S co ce EQUIPMENT / MILLWORK REMOVED Qn. DESCRIPTION 1 TURBOCHEF NGC OVEN tee. EHS 01 AS BUILT PLAN N —s RELOCATED CADDY AS SHOWN (2) NGO OVENS 0 .� t of o .. E � I <' '\ W U L Q t E- >- E w U 10- L � p L F- u O O (D p U rr z U � z o m Q fV0 m OF g � a� Q; Z cn { r I � U Q Li! EQUIPMENT / MILLWORK ADDED DESCRIPTION 2 TURBOCHEF NGO OVEN _HNISH — - o Z > H c �2 S ° Y a ProlsetMnpp DAV13018.0 07964 02 PROPOSED PLAN N.T.S.