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ELC-16-2789
Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-268956 PermitNumber: ELC-10-16-2789 Scheduled Inspection Date: October 24,2016 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: <NONE> Contractor: HARMISON ELECTRIC GROUP INC Phone: (305)969-5682 Building Department Comments ALTERATION INTERIOR ELECTRICAL WIRING , Infractio Passed Comments RECEPTACLES , FIXTURES INSPECTOR COMMENTS False Inspector Comme Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid October 21,2016 For Inspections please call: (305)762-4949 Page 27 of 44 AM rAZ 2'Me '��-�A Miami Shores Village �, �i 10050 N.E.2nd Avenue NEt ........ Miami Shores,FL 33138-0000 •` � Phone: (305)795-2204 4 „n �, PPItCY�C �'toxmP' Expiration: 04/15/2017 11 Aft- 0 7 Project Address Parcel Number Applicant 9488 NE 2 Avenue 1132060132780-88 Miami Shores, FL 33138- Block: Lot: MSVC LLC Owner Information Address Phone Cell MSVC LLC 2310 HOLLYWOOD Boulevard ()_ HOLLYWOOD FL 33020- Contractor(s) Phone Cell Phone $ 15,000.00 Valuation: HARMISON ELECTRIC GROUP INC (305)969-5682 Total Sq Feet: 0 Type of Work:ALTERATION INTERIOR ELECTRICAL WIRI Available Inspections: Additional Info:ALTERATION INTERIOR ELECTRICAL WIRI Inspection Type: Classification:Commercial Final Scanning:1 Meter Box Alteration Relocation Fire Alarm Service Change Review Electrical W.W. Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $9.00 Invoice# ELC-10-16-61652 DBPR Fee $6.75 10/17/2016 Check*13642 $440.50 $50.00 DCA Fee $6.75 Education Surcharge $3.00 10/14/2016 Check#:13263 $50.00 $0.00 Permit Fee $450.00 Scanning Fee $3.00 Technology Fee $12.00 Total: $490.50 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 authorize the above-nam ntractor o the work stated. October 17,2016 Authorized Signature:Owner / Applicant Contractor / Agent Date Building Department Copy October 17,2016 1 Miami Shores Village CEI Building Department OCT 14 2016 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY: , Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(30S)762-4949 FBC 201q'� BUILDING Master Permit No.CC-8-16-2167 PERMIT APPLICATION Sub Permit No. eLC 10 - Ib- 248°1 ❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL r-1 PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF [:]CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9488 NE 2nd AVE City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: 1132060132780-88 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Alteration Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder):Starbucks Coffee Company Phone#: Address:95 Merrick Way Suite#650 City: Coral Gables State: FL Zip: 33134 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: Harmison Electric Group, Inc. Phone#: 305-969-5682 Address: 12240 SW 128 CT#109 City: Miami State: FL Zip: 33186 Qualifier Name: Stephen C Harmison Phone#: 305-969-5682 State Certification or Registration#: EC0002144 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$15,000 Square/Linear Footage of Work: Type of Work: ❑ Addition 0 Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description ofwork: Alteration Interior Electrical wiring, receptacles,fixtures etc. Specify color of color th,Iru tile: Submittal Fee$ 0 ^`^ Permit Fee$ 8�' �� CCF$ CO/CC$ 3A° Scanning Fee$ Radon Fee$ DBPR$ _ Notary$ Technology Fee$ H '� Training/Education Fee$ 3 ' � Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ ' (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 certified copy of the recorded notice of commencement must be posted at the job site for the first inspectio occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will no pprove and a reinspection fee will be charged. Signature Signature OWNER or CONTRACTOR The foregoing instrtRent was acknowledged before me this The foregoing instrument was acknowledged before me this 14 day of 6 ClZ 201&)b,by 13th day of October 20 16 by tJ V� . ho is personally known to Stephen C Harmison ,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 ��►►�iiR a i i • .,: • Sign: Signs: Print: �• fJ Prini: Mibi Oico Seal: - Seal•,o ON ########### It ##########*###############################*##################################### APPROVED BY _ �yB'Gr/ Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) HARM101 OP ID:AM .4coRv CERTIFICATE OF LIABILITY INSURANCE FDATE 016Y) �►� 02/26/2016 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 policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policy may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NNAME aT Amy Mencla FILER INSURANCE,INC. PHONE 305-270-2169 FAX 9440 S.W.77 Avenue No No:305-270-2195 FL 33E-MAIL. KeithiIL Miller ADDRas:amencla0filerins.corn INSURERS)AFFORDING COVERAGE NAIC# INSURERA:Allied P&C Insurance Co 42579 INSURED Harmison Electric,Inc or INSURERB:Associated Industries Ins Co 23140 Harmlson Electric Group,Inc. INSURER C: 12240 SW 128th Court,#109 Miami,FL 33186 INSURER D 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 POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH 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. RM ROM EFF PO LTR TYPE OF INSURANCE POLICY NUMBER (MM POLICY LILY EXP LIMA A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000, CLAIMS-MADE r—x1 OCCUR ACP3016631184 02/27/2016 02127/2017 PREMISES Eao.,Ince $ 300, MED EXP(Any one person) $ 5100 PERSONAL&ADV INJURY $ 1.000. GEML AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2.000,00 POLICY F JECT F]LOC PRODUCTS-COMP/OP AGG $ 2A00, OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea aodderd) A X ANY AUTO ACP3016631184 02127/2016 02127/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per aaddent) $ AUTOS NONE-OWNED PR PERTY DAMAGE $ HIRED AUTOS AUTOS Per aoc�erh X UMBRELLA LU1a X OCCUR EACH OCCURRENCE $ 5.0O,Q0 A EXCESS LUUi CLAIMS-MADE ACP3016631184 02/27/2016 02/27/2017 AGGREGATE $ 5,000, DED I I RETENTION$ $ WORKERS COMPENSATION X - AND EMPLOYERS LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N AWC1059323 02/27/2016 02/27/2017 E.L EACH ACCIDENT $ 1,000.0 OFFICERIMEMBER EXCLUDED? N❑N/A (Mandatory in NH) E.L DISEASE-EA EMPLOYE0$ 1,000.00 Ndescribe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarta;Schedule,may be attached H more space Is required) Blanket additional insured applies via form CG2033(07104)and form CG7160 (08104). Blanket Waiver of Subrogation and Primary/Noncontributory coverage apply per form CG0001 (04113),when required in a written contract Lic#EC0002144 CERTIFICATE HOLDER CANCELLATION MIAMISH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Sham Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 10050 NE 2nd Avenue AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138 Aymara Mencia A269211 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD Ut IAL;H Htltt RICK SCOTT.GOVERNOR KEN LAWSON.SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD The ELECTRICAL CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2018 HARMISON, STEPHEN C HARMISON ELECTRIC GROUP INC. DADE CO. FAIR AND EXPOSITION 10901 S.W.24 STREET MIAMI FL 33165 �ao ISSUED: 07/04l2016• DISPLAYAS REQUIRED BY LAW SEQ# L1607040002242 tlOe887 Local Business Tax Receipt Miami-_Dade County, State of Florida THIS IS NOT A BILL—DO NOT PAY 7158400 BUSINESS NAME/LOCATION RECEIPT NO. tO(T] HARMISON ELECTRIC GROUP INC RENEWAL EXPIRES 12240 SUV 128 Cr #109 743GU7 SEPTEMBER 30, 2017 MIAMI FL 33186 Must be displayed at place of business Pursuant to County Code Chapter BA—Art,9&10 OWNER SEC.TYPE OF BUSINESS HARMISON ELECTRIC GROUP INC 196 ELECTRICAL CONTRACTOR PAYMENT RECEIVED STEPHEN HARMISON,QUAURER EC00021" BY TAX COLLECTOR Worker(s) 20 $125.00 08/09/2016 CREDRCARD-16-046542 This Local Business�q ��p� s payment of tire Local Business Tax fly is nota[icons, Perna ora qualillci ons,to do business.Hairier must wfth any or asegoverameatai aadrs��s which apply to the buslum govermnemtal The RECEIPT Na nissve must be displayed an an commercial vehicles—MiaM I—Dade Code Sec ga-276. For more inion a tion,v&k