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EL-15-980 (3) A Miami Shores Village Building Department RE 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 APR 2 A i Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 BY' 6 BUILDING Master Permit No.�;�]-13-'15� PERMIT APPLICATION Sub Permit No. EL— t5- cIG0 ❑BUILDING ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑CANCELLATION ❑ SHOP Q �_ / CONTRACTOR DRAWINGS 10B ADDRESS: 7-FJ�C� M�/2- )4� City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): 1��„� . f�3 Phone#: Address: city: w f State: zpe • Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: l�re1� t���fOGt e Phone#: Address: . City: ��'� /`� / State: Zip: �2 Qualifier Name: ,�f�� i� Phone#: State Certification or Registration M A`k 00/a,-f 3 8 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ / / Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: 1,/�L/�I�� (1/ " Ute Specify color of color thru tile: Submittal Fee$ Permit Fee$ .�S i U CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ / Structural Reviews$ Bond$ TnTAI CFC Wn%A/11110 4t � 7 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS,HEATERS,TANKS,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 0 NER or AGENT CONTR CTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this 19 .� lr i u� da of 20 c� b h da of 20 b who i ersonally cnow to NL —=3a,1 { -WttA who i personally kno 0 me or who has produced as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign: _lw4v 01 1 IN J. PALMEK p Le(/, ,••HY P•iMAII Print: '2 «�: Notary Public-State of Florida - Print: :z° �= NotaryPublic-State of Florida s: :oics _ ;My Comm.Expires May 23,2016 Seal: , �P,,, Commission # EE 1733;9016 842 Seal: ="r` «o` Banded Through National Notary Assn. =,;,fOF Commission # EE 1738,2 Bonded Through National Notary Assn. APPROVED BY / �� Plans Examiner Zoning Structural Review Clerk 7 RRCFINTFD c T1 APR 2 3 2015 Ti B L'. 13 - — D ■ 1750 SERVICE ITEN,ACCESSIBILITY CHART I 697/8-1 100 SERVICE ITEM 2 4L TVP _ (4"I OIL FILL CAP au niaar 0aa+ T 5 (MOUNTING HOLES) _ _ CENTER OF n �O E. OIL DIP STICK u«scar 0oon 1)MINIMUM RECOMMENDED CONCRETE PAD SIZE:1155(45 1/2')WIDE X 2255 -_- __. ._._.._. 746(29 1/4.1 OIIL FILTER ..au.En noon 1 anu agar coc+ (88 718')LONG REFERENCE INSTALLATION GUIDE SUPPLIED WITH UNIT I LOW VOLTAGE OL DRAIN HOSE FOR CONCRETE PAD GUIDELINES. AREA ONLY RADIATOR DRAIN HOSE Tanu-1000. 2)ALLOW SUFFICIENT ROOM ON ALL SIDES OF THE GENERATOR FOR MAINTENANCE 822 STUB UP AREA AIR CLEANER ELEMENT ..nu.err Doan AND SERVICING THIS UNIT MUST BE INSTALLED IN ACCORDANCE WITH CURRENT 1323/8-1 SEE NOTE 4 SPARK PLUGS -aa._Eer Doan APPLICABLE NFPA 37 AND NFPA70 STANDARDS AS WELL AS ANY OTHER FEDERAL TYP 102 MUFFLER see w.Ee STATE AND LOCAL CODES FOR MINIMUM DISTANCES FROM OTHER STRUCTURES. (MOUNTING 31 CIRCUIT BREAKER INFORMATION: HOLES) 14'1 SB FAN BELT scE ao.e c (o SEE SPECIFICATION SHEET WITHIN OWNERS MANUAL I / 1 BATTERY Tams iEFr noon � � 12 114-1 4)INSIDE STUB-UPAREA FOR AC LOAD LEAD CONDUIT CONNECTION.NEUTRAL I' - 1 REFERENCE OWNERS MANUAL FOR PERIODIC o CONNECTION,BATTERY CHARGER 120 VOLT AC(0 5 AMP MAX.)CONNECTION.AND �"" 1 1 REPLACEMENT PART LISTINGS ACCESS TO TRANSFER SWITCH CONTROL WIRES.REMOVE FRONT COVER FOR ACCESS. BATTERY 12 VOLT 26F p 4A)FIELD CUT HOLE IS ONLY REQUIRED FOR MOUNTING OF GENERATOR ON AN 525 COLD CRANKING AMPS EXISTING PAD. 914 _ 5)REFERENCE OWNERS MANUAL FOR LIFTING WARNINGS 13.5117!32")DIA.MOUNTING 13 5/8-1 381 195 6)REMOVE EITHER LEFT OR RIGHT HAND SIDE PANEL TOACCESS EXHAUST MUFFLER HOLE L4)PLACES — (151 - (7 3/4'1 < LOCATED ON BOTTOM OF (n AND FAN BELT �p�E� VISE ACTION LATCH. GENERATOR MOUNTING FRAME ONE PER DOOR,ONE LIFT-OFF 3 DOOR PER SIDE OF GENERATOR N — 1950(76 3/4.1 EXHAUST AND AIR DISCHARGE CONTROL PANEL ET LOUVERS-FRONT AND SIDES 1139 144 13116'1 BATTERY CHARGER IS — 850 133 112'1 DOOR TYP ENCLOSED WITHIN + (.Tr _ EXHAUST MUFFLER —EEE I ___EEE_= lF 11455 —_ 3 EEE— t ENCLOSED WITHI ___ N. I iEE___ R -.117 _€ 145 118') i —— k SEE NOTE 6 t. _ (NO 13 5(17/32'')DIA MOUNTING I =——__ j = 884 i =_— s = - _— FRONT COVER c !{ � HOLE(4)PLACES,12.7(12') ---- - --- SEE NOTE = 13413/16'1 C:) DIA MASONRY ANCHOR DOOR i 6EE ZE BOLTS RECOMMENDED 5 ll�_ = TYP T E CIRCUIT BREAKER }p 152.5 AIR INLET i525 1525 1525 I2 5 — — 52 52 — � SEE NOTE 3 _E 16'I LOUVERS C.lr MIN I MIN MIN ._— .. �! ,� MIN / .. .. 495 1 FRONLV�EW [2'1 LEFT..WE.V_W STUB-UP LIFTING PROVISION BEAR VIEW CD CONCRETE MOUNTING PAD AREA (4)PLACES SEE NOTE 5AND (SEE NOTE 1) NATURAL GAS CONNECTION 1-1/4"NPT FEMALE. 1000(39 318 — CENTER OF GRAVITY DIMENSIONS W •A�,���IJR.0• 0 0 ••• 0 : ••. LPV CONNECTION 314"NPT FEMALE COUPLING FIELD CUT HOLE.FOR OUTSIDE CONDUIT ��0 �:'3.w •"It r�,0 • • • • LOCATED ON THIS SIDE(LH) CONNECTION ONLY.SEE NOTE 4A CTT r.mu um. , .• Au ry,., '• .'111-- *�^• ••• • G) cl? dl" .. YI• .. • • • .. V! 23 gom z ... . . m .. . . . . . . . . . ••• • ••• • •.. . = t7 ... . . . ... . . . .. .. . . . .. .. •. • • ♦ • . :o: • • •• .t• .. . • • .• PLUMBING PLANS Approved Date=y5 gate I FT rFD► ! ' j C" T1 APR 2015 in in BY --- --. r a D 17550 SERVICE ITEM ACCESSIBILITY CHART s 168718"] _ 100 SERVICE ITEM 2.4L TYP I� 14"1 OIL FILL CAP eau uonT 000a (MOUNTING HOLES) CENTER OF OIL DIP STICK T IDOOa GRAVITY 1)MINIMUM RECOMMENDED CONCRETE PAD SIZE:1155(45112')WIDE X 2255 �T___-_ I 746[291/4"] OIL FILTER Tau�evr000a (88 718')LONG.REFERENCE INSTALLATION GUIDE SUPPLIED WITH UNIT ) OIL DRAIN HOSE Tau axa,r000a FOR CONCRETE PAD GUIDELINES. AREA ONLY GE RADIATOR DRAIN HOSE THRu EVTI o R 2)ALLOW SUFFICIENT ROOM ON ALL SIDES OF THE GENERATOR FOR MAINTENANCE 822 STUB-UP AREA AIR CLEANER ELEMENT T--­ AND SERVICING.THIS UNIT MUST BE INSTALLED IN ACCORDANCE WITH CURRENT 132 318"I 1• SEE NOTE 4 SPARK PLUGS T�au:Ert 000a APPLICABLE NFPA 37 AND NFPA70 STANDARDS AS WE LL AS ANY OTHER FEDERAL TVP 102 MUFFLER see Horse STATE AND LOCAL CODES FOR MINIMUM DISTANCES FROM OTHER STRUCTURES. (MOUNTING - HOLES) 14"1 FAN BELT SEE NOTE6 3)CIRCUIT BREAKER INFORMATION: [ 58 BATTERY au I SEE SPECIFICATION SHEET WITHIN OWNERS MANUAL + -.I A I 12 1/4"] rw ErToaoa 4)INSIDE STUB-UP AREA FOR AC LOAD LEAD CONDUIT CONNECTION.NEUTRAL ( - - I REFERENCE OWNERS MANUAL FOR PERIODIC dCONNECTION,BATTERY CHARGER 120 VOLT AC(0.5 AMP MAX.)CONNECTION,AND - [ REPLACEMENT PART LISTINGS O ACCESS TO TRANSFER SWITCH CONTROL WIRES.REMOVE FRONT COVER FOR ACCESS. BATTERY 12 VOLT 26F p 4A)FIELD CUT HOLE IS ONLY REQUIRED FOR MOUNTING OF GENERATOR ON AN 525 COLD CRANKING AMPS EXISTING PAD. 91.4 5)REFERENCE OWNERS MANUAL FOR LIFTING WARNINGS. 13.5(17/32")DIA.MOUNTING (35/8") 381 195 6)REMOVE EITHER LEFT OR RIGHT HAND SIDE PANEL TO ACCESS EXHAUST MUFFLER HOLE(4)PLACES [15"1 (7 3/4'1 LOCATED ON BOTTOM OF TOP VIEW y AND FAN BELT VISE ACTION LATCH. GENERATOR MOUNTING FRAME ONE PER DOOR,ONE LIFT-OFF 1950[76 314"] DOOR PER SIDE OF GENERATOR , EXHAUST AND AIR DISCHARGE CONTROL PANEL LOUVERS-FRONT AND SIDES 1139(44 13116') BATTERY CHARGER IS 650(33 112"1 n DOOR TYP ENCLOSED WITHIN CCS .. .. .._. - Cn _ EXHAUST MUFFLERr [ 1145.5 i✓ o __ ENCLOSED WITHIN, [( J451/8"1 E SEE NOTE 1 (D 13.5(17132")DIA.MOUNTING I o_—'c-c =B FRONT COVER — 884 3 c c CCD HOLE(4)PLACES.12.7(1/2") — SEE NOTE 4 —' 134 DOOR 7 e c CD DIA.MASONRY ANCHOR = BOLTS TVP RECOMMENDED u — 1525 E 152.5 152.5 (CIRCUIT BREAKER 116"] AIR INLET Iltl SEE NOTE 3 [€ (6'] LOUVERS 6" _ _ 161 [6"1 _— _ — U'i MIN MIN. MIN _...._.. ,�- MIN. I (D r i _ L i [ T —1. 49.5 rn FRONT VIEW (2'J LEE7 SiD lEkY STUB-UP LIFTING PROVISION REAR VIEW CONCRETE MOUNTING PAD AREA (4)PLACES,SEE NOTE 5 AND ? (SEE NOTE 1) NATURAL GAS CONNECTION:1-114"NPT FEMALE. 1000[39 3/81 — CENTER OF GRAVITY DIMENSIONS n1 LPV CONNECTION 314"NPT FEMALE COUPLING FIELD CUT HOLE FOR OUTSIDE CONDUIT 11—' .&P • o—,-6 •• LOCATED ON THIS SIDE(LH) CONNECTION ONLY.SEE NOTE 4A • • IN 10 a m Z CD .. . . . . . _ E3 .. . . . . o ... 0 ... . . . . . . . . . . • •• •• • • • •• •• ••• • • • ••• • • • 1 E IC Series ... . . . ... . . . .. .. . . . .. .. . . . . . . . . . . .. . . . . . . . . . . ... ... PLUMBING PL, •• .•. .. . . .. Approved ® Date Z?�S . .. . . . . ... . Pp T?i sa_pproved ate .. ... . . . . . .. AC"R CERTIFICATE OF LIABILITY INSURANCE I DATE(NMIDO/YWY) 04/23/15 -— -- -- - --- -— --- 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OLDER.THIS - CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY T E POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),A UTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the ' pdicy(ies)must be endorsed. ff SUBROGATION IS WANED,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 lieu of such endorsement(s). PRODUCER CONTACT GLADYS DELGADO -NAMMutual Insurance Group Of Florida I PHONE (305)820-0600 -��x (3.05)820-0670_ 5580 W. 16th Avenue,Suite#105 ,E,,n ESS, gtadysarnutualinsurancefl com - -- Hialeah,FL 33012 __-INSURER(S)AFFORDING COVERAGE _ _ _ _ NAIC K Phone -- (305)820-0600Fax (305)820-0670 __iNsuRERA. ASCENDANT COMMERCIAL I j INSURED - -_ INSURER B-----. - -- HIGHGRADE ELECTRICAL INSURER C, I 3613 SW 167 AVE INSURER D: i HOLLYWOOD,FL 33027 (786)357-8728 _INSURER E: -- _ 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 POU Y PERIOD I INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO HICH THIS CERTIFICATE MAYBE 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. N6SRTYPE OF INSURANCE ��D� POLICY EFF POLICY EXP - - II _-POLICY LIMIT.' -- ----- ------ R GENERAL LIABILITY ! 1 EACH OCCURRENCE _ $ 1,000 OO_0.00 17/1 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMaES 100,000.00 ❑ ❑ CLAMS-MADE © OCCUR GL-46664-0 _ __ A $ 5,000.00 ---- I ❑ 01/08/2015 01/08/2016 PERSONAL&ADV INJURY { $ 1,000 000.00 I El GENERAL AGGREGATE I $ 2,000,000.00 _ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG I $ 4. _POLICY ❑ PRO- [jLOC CT I AUTOMOBILE LIABILITY j - 1 C OM13INEE niSINGLE LIMIT $ ❑ ANY AUTO j .,BODILY INJURY(Per person) $ ❑ AUTO ALL S�ED ❑ ASUTOSCHEDU�D BODILY INJURY(Peracadenta $ NON-01NNED ROPER�T AMAGE - ❑ $ 1 Li HIRED AUTOS _ AUTOS -�_... . ❑- ._ ._- .-T___.___.... ❑ ❑OCCUR ------- --_ EACH OCCURRENCE $ ❑❑ DED ❑ BUMBRELLA RETENTION$ I J CLAIMS-MADE -------- _--- �ANDEMPWORKERS YERS'LSATION -- ❑TORY LIMIWC STAT"TS ❑_ER � $ OFFICE I EMBE'EXCLUDED? N/A AND EMPLOYERS'LU161LITY Y I N ANY PROPRIETORIPARTNER/EXECUT VE E.L.EACH ACCIDENT $ _ (Mandatoryin NH E.L-DISEASE-EA EMPLOYEE S ' It yes,describe ufldef �', � - _ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LP T $ i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) {ER0015138 s CERTIFICATE HOLDER CANCELLATION i I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CA IINCELUED BEFORE VILLAGE OF MIAMI SHORES BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 NE 2ND AVE ACCORDANCE WITH THE POLICY PR IONS. MIAMI SHORES,FL 33138 AUTHORIZED REPRESENTATIVE ©1 - D ORPORATION. All rights reserved. ACORD 26(2010/05)OF The ACORD name an go are registe d marks of ACORD HIGHGRADE ELECTRICAL CO., 3613 SW167 AVE HIALEAH, FL. 33027 DATE: APRIL 26T"/2015 STATE OF FLORIDA COUNTY OF DADE BEFORE ME THIS DAY APPEARED 2- 7 WHO, BEING DULY SWORN, DEPOSES AND SAYS: THAT HE OR SHE WILL BE THE ONLY PERSON WORKING ON THE PROJECT LOCATED AT: 9350 NE 12 AVE,MIAMI SHORES, FL. 33138 SWORN TO(OR AFFIRMED)AND SUBSCRIBED BEFORE ME THIS _DAY OF 2015 BY /V k-= Sd y_/ L&I - PRINT&SIGN PERSONALLY KNOWN OR DID PRODUCE FDL# JOSE M.SANTANA _aQ`�Y• <� Notary Pubk-State of Fiorids s N My Comm.ExOres Fob 24.2017 '+ �� Commtisioo 0 EE 877449 r „off s r bedld NMionN Notyy Apn. S�OC.RFS GQ '� Miami shores Village legs , BIIII Building Department 'rile rNA 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Notice to Owner — Workers' Compensation Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure: An employer in the construction industry who employs one or more part-time or full-time employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt i£ 1. The officer owns at least 10 percent of the stock of the corporation, or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to work on your project. In these circumstances,Miami Shores Village does not require verification of workers' compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS. Signature: --- Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this T day of 20 By who who ' ersonally kn o me or has produced ......„ MARTIN J.PALMER as ident' tc �e•.,, =o� ;�; Notary Public State of Florida My Comm.Expires May 23,2016 Notary: s.,f P; Commission#EE 173842 Bonded Through National Notary Assn. SEAL: