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ELC-15-2602 Miami Shores Village £ 10050 N.E.2nd Avenue Miami Shores,FL 33138-0000 54 m r yak inn: z 2 y u�� ,r � i� ,yt�r;��� E �a.4:. ����'�4���it,} ,� •3a•. Phone: (305)795-2204 a i � Expiration:04118f2016 Project Address Parcel Number Applicant 9020 BISCAYNE Boulevard 1132060110120 WAL MIAMI LLC Miami Shores, FL Block: Lot: Owner Information Address Phone Cell WAL MIAMI LLC 275 MADISON Avenue NEW YORK NY 10016- 275 MADISON Avenue NEW YORK NY 10016- Contractor(s) Phone Cell Phone Valuation: $ 900.00 HAMILTON ELECTRIC (561)210-5263 Total Sq Feet: 0 Type of Work:INSTALL 3 POWER STRIPES,1 2X4 LIG Available inspections: Additional Info: Inspection Type. Classification:Commercial Final Scanning:3 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical Underground W.W. Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $0.60 Invoice# ELC-10.15.57415 DBPR Fee $2.25 10/21/2015 Credit Card $159.10 $0.00 DCA Fee $2.25 Education Surcharge $0.20 Permit Fee $150.00 Scanning Fee $3.00 Technology Fee $0.80 Total: $159.10 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS 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 zQpuiq. Futhermore'I authorize the above-named contractor to do the work stated. h October 21 2015 Autho ed Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy October 21,2015 1 Inspection Worksheet Miami Shores Village ac 15- 10C12J 10050 N.E.2nd Avenue Miami Shores,FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-245659 Permit Number: ELC-10-15-2602 Scheduled Inspection Date:April 19,2016 Permit Type: Electrical-Commercial Inspector. Devaney, Michael Inspection Type: Final Owner. HERMELEE,BRUCE Work Classification: Addition/Alteration Job Address:9020 BISCAYNE Boulevard Miami Shores,FL Phone Number Parcel Number 1132060110120 Project: <NONE> Contractor. HAMILTON ELECTRIC Phone:(561)210-5263 Building Department Comments INSTALL 3 POWER STRIPES,1 2X4 LIGHT. 1 OUTLET Infraatio Passed Comments AND 1 SINGLE POLE SWITCH INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction Needed ❑ Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid April 18,2016 For Inspections please call: (305)762-4949 Page 4 of 25 Miami Shores Village R e4 Building Department OCT 1,4 2 15 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax.(305)756-8972 BY: INSPECTION UNE PHONE NUMBER:(30S)762-4949 FBC 201 BUILDING Master Permit No.CCI 51092 PERMIT APPLICATION Sub Permit No. EL- IS—L607i []BUILDING ©ELECTRIC ❑ ROOFING ❑ REVISION 0 EXTENSION ❑RENEWAL ❑PLUMBING ❑MECHANICAL []PUBLIC WORKS F1 CHANGE OF ❑CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS. 9020 Biscayne Blvd. City Miami Shores County Miami Dade Zip• /parce11-3206-011-0120 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: 8FE: FFE: AA� Name(Fee Simple Titleholder):Wal Miami LLC Phone#: � /2-q9®--00 0 .246,Madlson Ave 30th Floor City: New York state: NY p; 10016 Tenant/Lessee Name:Walgreens Co Phone#: Email: CONTRACTOR:Company Name: Hamilton Electric Phone#: /-d/O—S A6,3 Address: 2701 NE 27th Cirde City: Boca Raton State• FLgyp: 33431 Qualifier Name: Mark Hamilton Phone#.J' State Certification or Registration#:EC-1-3 00 c�'J�ZZ Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ .&-00 -C-Co, Square/Unear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Repiace ❑ Demolition Description of worn: zK(/ Specify color of color thru We: �I Submittal Fee$ Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Educadon Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (RwL KWW4/s014) 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$250Q, 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 certifled copy of the recorded notice of commencement must be posted at the job site for the fust 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. WA- l Iq-/o/ I.LG Signature v Signature OWNER or AGENT CONTRACTOR The foregoing instrumeni was acknowledged before me this The foregoing instrument was acknowledged before me this day of d C 20 I .by -7 day of 5�� 6- .20 f .by .who Is personally known to & A/'#nat, who is personally known to 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 P Si Sign: P? v 9 . RK Print: Wl iA as Seal: N'0. 4707559 Seal: QIJA iF! IN NASSAU COUNTY ,,,,�`•:, .ieTinyMebSy4 C0M;?J 8^!Q^� EXPIRES APRIL 30, 2049 i�, St eof Fk ida BLY COMMISSION A APPROVED BY / e��s` Plans Examiner Zoning Structural Review Clerk (ReYM 02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL.REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD (850)487-1395 a 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 HAMILTON, MARK HAMILTON ELECTRIC 2781 NE 27TH CIRCLE BOCA RATON FL 33431 Congratulatlorwl With Oft Bcense you b one min Floridians lensed by the Department of Business and Professional Regulation. Our professionals and businesses range : STATE OF FLORIDA wW y"�to edt economy Wong. tO DBUSINESS AND PROF ULA11ON Every day we work to improve the way ws do business�t order to EC-13006694, '{x ; 5/12/2015 SIM you better: For h1brmation about our services,please log onto Y x about�dhriaior�and the re. Time you can gulat�rtstltat find more irrformat�rr CERTIFIED R to departmer newsletters and team more a theDpact �s HA(WILTHAiWILtQN�- irittatives. EL W fA Our mission at the DePWIM nt Is License EFficlently,Regulate Fairly. We constantiv strive to serve you better so that you can serve your customers. Thank you for d s in Florida, tS�ERi 1Fifb under the,orovistons of$h.488 FS. A' and congratulations on your raw kensei _ ua+' a nuo Vii,sere ii6fl312a000e¢4 ✓ _' V � yam ptr f DETACH HERE RICK SCOTT,GOVERNOR KEN�A �.- --- -- _- --- --w yM � WSON,SECRETARY STATE OF FLORIDA F DEPARTMENT OF BU0*83 AND PROFESSIONAL REGULATION EL9CTMCAL--qQW, RACTORS LICENSING.BOARD � ✓ j E;0'130 4 -Tla$-ELECTRICAL CONTRACTOR N bilow IS CERTIFIED _ the' r8.of-C 489F&-- -. - haps s s � ;AUG-3!;20:115 ISSUED: 05f1202015 DISPLAY AS REQUIRED BY LAW SEO# LISM12WO0824 LOCAL BUSINESS TAX THIS IS NOT A BILL RECEIPT# 16 00041530 CITY OF-$4CA RATON AM chltein name,address, suite,ownership,ect.will BUSINESS TAXAUTHORITY anew application 201 WEST PALMMTO PARK ROAD 15 days to avoid BOCA RATON FLA.33432-3795 and penaltyvoidor the license is null HAMILTON ELECTRIC HAMILTON,MARK 2701 NE 27 CHL RUSE T RECEEPT Business Tax fee: 105.00 GRT LATE OF USE' i tee ' :00 s: 9130116 Additional fee: .00 HAMILTON ELECTRIC Transfer fee: .00 2701 NE 27 CIR Total paid: 105.00 BOCA RATON FL 33431 nes paid the business tax at the above adder for the period beginning the 1st day of October and ending the 30th day of Clmmen s: HOME OCCUPATION September to-engage in the business,p orComments: ELECTRICAL CONTRnCTCn -occupation-oF Restriction: -COA+I�.�wlTT3.CQDE S�TION Z8-2533 Welcome to the City of Boca Raton. We are proud to have your business in our community. You may call us at 561-393-7937 if you have questions relating to your business needs.Office hours are 8:00 AM to 4:00 PM,except Wednesday the hours are 8:00 AM to 3:00 PM. Please verify all information on your Business Tax Receipt and notify us immediately if there is an error. ALL CHANGES REQUIRE A NEW APPLICATION.Visit our website at:WWW.MYBOCA.US, "Quicklinlc" to Business Tax to download applications and to verify business information. Applications must be submitted in person with apppropiate documentation and fee. If the business has closed or moved outside the City limits,you are required to notify the City in writing. Please post this"Business Tax Receipt"at the above location in a place where it may be seen at all times. A courtesy renewal notice will be sent 30 to 60 days prior to expiration. If you do not receive the renewal notice, you must still pay the tax on time.Late penalties will not be waived if you do not receive the notice.The Business Tax may be renewed in person, by drop-box within City Hall, by mail or by using the website and click "online services"from the homepage.To renew online you will need your Business Tax Receipt#and your"pin"# These numbers will be provided on your renewal notice. We accept checks, cash, money order, Visa, MasterCard or American Express as a method of payment.Check must have Business Tax Receipt#and be made payable to the City of Boca Raton.DO NOT MAIL CASH.Failure to pay your Business Tax on or before the close of business on September 30 will cause penalties to be applied to the renewal tax as indicated below. .AL EMM t F SINE LOCATION DATE PENALTY PAYMENT AND PENALTY SCHEDULE EFFECTIVE: SEPT 30 OCT 1 NOV 1 DEC 1 JAN 1 MAR 1 PENALTY 0•/0 100/0 15% 20% 25% 25%+$250.00 ti CERTIFICATE OF LIABILITY INSURANCE F0/9/20151ND/YYYY) 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(Sh AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: iftic certificate holder Is an ADDITIONAL INSURED, the policy(fes) must be endorsed. if SUBROGATION IS WANED, subject to the terra and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holdw In Neu of Wk andommentle)._ PRODUCER ja . VAN- SODS Work Comp ,Systems PHONE 863-438-2710 863-438-2711 711 E. Main Street, STE #1 Haines City, FL 33844 s VZSCO INSURANCE CCWMM 25011 INSURED M.HAMILTON ELECTRIC, LLC DBA INSURERS: PROGRESSIVE INSURANCE COMPANY 2 HAMILTON ELECTRIC 2701 NE 27TH CIRCLE INSURER : BOCA RATON, FL 33431 561-210-5263 INSURER F THIS S TO CERTIFY THAT THE POLCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERN!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 S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONSOF SUCH POLICIES.OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MRLTR TYPE OF INSURANCE LIMITS X COMMERCIAL NERAL UARKM FI OC URRENCE S 1,0 0,000 CLAIMS-MADE ®OCCUR 100,000 MPP140411200 09/23/1 9/23/1 Is 5 000 A PERSONAL&ADV INJURY 1,000,000 GENL TELIMITAPPLIESPM GENERAL TE 2,000,000 B POLICY -- 0 LOC PROD -c IPSP Am s 2,000,000 AUTOMOSILEUABIUW WWNMELIMIT $ 100,0 ANYAUTO BODILY INJURY(Per PMM) $ ALLOWNED M SCHEDULED BODILY INJURY(ParaoddeM $ AUTOS UT06M MED 03716870-9 0/09/10/09/1 $ AUTOS UMBRELLA UAB OCCUR EACH OCCURRENCE EXCESS UAB AGGREGATE WIDRIa rtsCOMPENSATION AND EMPLOYERS'LIABILITY ANY E OM RR EXCLUDED? C E N NIA 0 @landul In NM 2127372401 09/23/1509/23/16 EACH ; . e deeor�e�er 1,000,000 DESMIPTIONOFOPERATWNSILOCATIOISIVEHICLES(ACORDioi. R Sdte",MaybeaftdedHrwaepaoelsregtdred) 30 days written notice in the event of cancellation. MARK HAMILTON-LIC# EC13006694. re: 9020 BISCAXNE BLVD.-SUPPLY AND INSTALL ALL ELECTRICAL MATERIALS, EQUIRNENT, PROVIDE TESTING AND DELIVER EQUIPMENT PER PLANS/SPECIFICATION$ INCLUDING NECESSARY DISCONNECTION AND DEMOLITION. MIAMI SHORES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 HE 2ND AVENUE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MIAMI SHORES VILLAGE, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: BUILDING DEPARTHRUT AUTHsE FAR# 305-756-8972 ®1988-2014 ACORD CORPORATION.All rights reserved. ACORD 26(2014/01) The ACORD nerre and logo are registered rrarim of ACORD