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DEMO-15-2591 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-245578 Permit Number: DEMO-10-15-2591 Scheduled Inspection Date: February 04,2016 Permit Type: Demolition Inspector: Devaney, Michael Inspection Type: Final Owner: SUB LLC,SRP TRS Work Classification: Electric Job Address:78 NW 107 Street Miami Shores, FL 33168- Phone Number (954)671-1400 Parcel Number 1121360070070 Project: <NONE> Contractor: VICON ELECTRIC INC Phone: 954-486-7010 Building Department Comments DEMO KITCHEN AND BATH Infractio Passed comments INSPECTOR COMMENTS False Inspec r Comments Passed � C' 373' Failed ®� Correction r Needed614'It491 _ Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. February 03,2016 For Inspections please call: (305)762-4949 Page 11 of 35 a� Miami Shores Village / � G#ernoion �,. 10050 N.E.2nd Avenue NW Miami Shores,FL 3313&0000 ' � R 0 Phone: (305)795-2204 Issuel ate: 101211201116Expiration: 04/18/2016 Project Address Parcel Number Applicant 78 NW 107 Street 1121360070070 Miami Shores, FL 33168- Block: Lot: SRP TRS SUB LLC Owner Information Address Phone Cell SRP TRS SUB LLC FL (954)671-1400 1999 harriosn Street oakland CA 94612- Contractor(s) Phone Cell Phone Valuation: $ 200.00 VICON ELECTRIC INC 954-486-7010 . .. .. _..,..._._ Total Sq Feet: 00 Type of Demo:Electric Available Inspections: Additional Info:DEMO KITCHEN AND BATH Inspection Type: Classification:Residential Final Scanning:3 Fees Due jAmnPay Date Pay Type Amt Paid Amt Due CCF CCF Fee Invoice# DEMO-10-15-57404 DBP10/21/2015 Check*6767 $ 114.60 $0.00 DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: 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 zoning. Futhermore,I authori the above-named contractor to do the work stated. October 21, 2015 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy October 21,2015 1 r Miami Shores Villag =BY. Jr— Tel: Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 A/ BUILDING PERMIT APPLICATION Master Permit Sub Permit No � / ❑BUILDING M ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL 'C ❑PLUMBING []MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑CANCELLATION El SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 78 NW 107 ST CityMiami Shores County Miami Dade Zip Folio/Parcels:11-2136-007-0070 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):SRP TRS SUB LLC Phone#: Address:2700 W CYPRESS CREEK RD D 118 City: FORT LAUDERDALE State: FL zip: 33309 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Vicon Electric Phone#: Address: 520 SW 63rd Terrace City: Margate State: Florida alp: 33068 Qualifier Name: Glen Grant Phone#: State Certification or Registration#: ECO002072 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address City State• Zip: Value of Work for this Permit:$ DC)C) Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ i Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: rll E'k' k)- Specify color of color thru tile: Submittal Fee$ Permit Fee$��'�Q'd CCF$ C0/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double�ee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ I (Revised02/24/2014) 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 certifled 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 . *was NT —4-—.F4. CONTRACTOR The foregoing' ruledged before me this The foregoing instrument was acknowledged before me this day of 20 by �_day of 10 20 15 by who s personally known t Gk,, G rcc wh Is persanaliy known 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 path. NOTARY PUBLIC: NOTARY PUBLIC: Sign Sign: Print Print: Seal: INY'n�3° T fJAQINE AUSTERFIELD Seal: /�.., IL. Notary Public-State of Florida " "\3 'IJADINE AUSTERFIELD t; G mnissian Expires W,7,20171 t �� \° _ Notary Public]-State of Florida ix0ires Mul77.20171•11n _. Of't APPROVED BYy. _ 'Plans Examiner � -- Zoning Structural Review Clerk (RevisedOZ124/2014) .4 v CERTIFICATE OF LIABILITY INSURANCE 3/19/201 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: N the cerEFflcate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SU TION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this cwW c*w does not confer rights to the Certificate holder in Neu of such endorsement(s). PRODUCER NAAIg: David Ra no Reyes Coverage Insurance PHONE 5900 Hiatus Road - Tamarac FL 33321 ADORES& dra o ke escovera e.gom PRODUCER 13228 INSURED INSURER(S)AFFORMHO NAICA INSURERA:Associated Industries Ins. Co. 23140 Vicon Electric, Inc 520 SW 63 Terrace INSURERB:Wesco Insurance Co Margate FL 33068 aLsuRERc: INSURER D INSURER E: IAF: COVERAGES CERTIFICATE NUMBER:1434441087 R I EVISIOP I JNUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE OR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER ROCU WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED IS SUBJECT TO ALL TIME TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID MS. INLTR TYPE OF INSURANCE POLICY NUMBERPOLICY EFF POLICY EXP Lam 8 GENERAL LIABILITY Y NPP1155789-00 3/19/2015 3/19/2016 EACH RRENCE $1,000,000 X COMMERCIAL GENERAL LIABUUIY PREMISES $50,000 CLAGNS-MADE a OCCUR MED EXP am ,) $10,000 PERSONAL ADV INJURY $1,000,000 GENERAI TE $2,000,000 GEMLAGGREGATE LIMITAPPLIES PER: PRODUCTS'COMPIOP AGG $2,000,000 POLICY PRO- F-IJECT F1 LOC $ AUTOMOBILE LIABILITY COMBINED Emir $ We socident) ANY AUTO BODILY INJURY(Per psora) $ ALL OWNED AUTOS BODILY INJURY(Per ecdit $ SCHEDULED AUTOS ODI PROPERTY DAMAGE HIRED AUTOS (POa� $ NON-OWNED AUTOS $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESSLIAB CWMSMADE $ DEDUCTIBLE $ RETENTION $ A WORKERS AND OYCOMP�N TIOIN ARC1038107 11/20/2014 11/20/2015 X TUC ST 711 OTH Y 1 N Y PROPRIETOR/p� AN OFFlCEWkEMBER EXCLUDED? N f A E.L.EACH ACCIDENT $500,000 In NM E.L.D -EAEMPLO $500,000 1describe under DF R1PTION OF OPERATIONS below EL DW-&%-POLICY I.MaT 1$500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Atm ACORD 101,Additional Remarks Sehedule,U mom space is n,"beo License no. EC0002072 CERTIFICATE HOLDER CANCELLATION30 Das Notice /'10 Das for Non-Pa SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TH WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY pR01irSINn,S Miami Shores Village Building Department 10050 N.E. 2nd Avenue AUTHORIZEDREPRESSIFIATIVE Miami Shores FL 33138 l/1 O 1988-2009 ACORD CO RATION. AN rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered manta of ACORD BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm.A-100, Ft Lauderdale, FL 33301-1885—954-831-4000 VALID OCTOBER 1,2015 THROUGH SEPTEMBER 30,2016 DBA.VICON ELECTRIC INC Receipt#:ELECTRICAL/ALRrZhIS/COI�TRnC'�R Business Name: Business Type:(ELECTRICAL CONTRACTOR) Owner Name:GLEN E GRANT Business Opened:©1/01/1994 Business Location:520 SW 63 TERR $tat01C0pMy/Cer1JReg•EC0002072 (MARGATE Exemption Code: Business Phone:954-486-7010 Rooms Seats Emptoyess Machines Professlonals • 1 Far Vint 9 Gudnms Only Number of Machines: Tax fvnounl TrerWW Fee I NSF Fee Penalty Prior Years CodecGon Cost Total Paid 27.00 0.001 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 aU County and/or Municipality planning WHEN VAUDATEO 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 locztion.This receipt does not indicate that the business is legal or that it is in compliance with State or local Ism and regulations. Mailing Address: GLEN E GRANT Recaipt #138-14-00010945 520 SW 63 TER Raid 09/25/2015 27.00 MARGATE, FL 33068 2015 - 2016 t�t�?A1i1lARfil_`.1111>AIT1f.E nr+w it Qr�crtul�� rwv ,Dr��,nT .__...--