EL-17-1872 �\\ Miami Shores Village RECEIVED
�ti � g EOVE®
Building Department Jul 20 2017
10050 N.E.2nd Avenue,Miami Shores,Florida 33138
Tel:(305)795-2204 Fax:(305)756-8972 /
INSPECTION LINE PHONE NUMBER:(305)762-4949
FBC 201Q
BUILDING Master Permit No. 61
PERMIT APPLICATION Sub Permit No.
❑BUILDING rffi� ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION RENEWAL
❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9401 BISCAYNE BLVD 2
City Miami Shores County: Miami Dade Zip: �J J ✓�
Folio/Parcel#: 11-3206-049-0010 Is the Building Historically Designated:Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER:Name(Fee Simple Titleholder):EDWARD A MCCARTHY ARCHBISHOP phone#:305-762-1032
Address:9401 BISCAYNE BLVD
City: MIAMI SHORES State: FL Zip: 33138-2970
Tenant/Lessee Name: Phone#:
Email: kbost@theadom.org
CONTRACTOR:Company Name: HAIRSTON-STEVENS ELE CONST INC Phone#: 954-587-7335
Address: 7441 NW 11TH PLACE
City: PLANTATION State: FL Zip: 33313-5915
Qualifier Name: JAMES M HAIRSTON Phone#: 954-587-7335
State Certification or Registration#. EC0000957 Certificate of Competency#:
DESIGNER:Architect/Engineer: Phone#:
Address City: State: Zip:
Value of Work for this Permit:$ )L a 0 Square/Linear Footage of Work:
Type of Work: F-1Addition [:1 Alteration F-1NewRepair/Replace ❑ Demolition
Description of Work: Replace existing parking lot fixtures to LED lighting with same effect.
Specify color of color thru tile:
Submittal Fee$ Permit Fee$ 0 6 CCF$ CO/CC$
Scanning Fee$ Radon Fee$ Z�k DBPR$ 7 Notary$
Technology Fee$ Training/Education Fee$ Double Fee$
Structural Reviews$ Bond$
TOTAL FEE NOW DUE
(Revised02/24/2014)
Bonding Company's Name(if applicable) AJ
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 41a 11,L Signature
0 NER or AGENT 0ONTRA OR
The foregoing instrument was acknowledged beforre�me this The foregoing instrument was acknowledged before me this
_ day of 20 I ,by day of 20 by
�• ���Z ,be*A VV94��P� who is perso y known to �� "` �k�.ct< sem' ,who is personally known to
me or who has produced as me or who has produced as
r--
identification and who did take an oath. identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign: 9 ` Sign
Print: 0. (e,&A tvl• Tao J Print:
Seal: :, `•:; KATHL.EEN M� ,,
•= MYCgy1b9ISSlONt FF216826 Seal: �q�• 4g JtJANBAUZA
.; My COMMISSION#GG 103217
EXPIRES Apri102.2018 EXPIRES;Maly 13,2021
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APPROVED BY i~ A YPIans Examiner Zoning
Structural Review Clerk
(Revised02/24/2014)
t c
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
That the most Reverend Thomas Wenski, as Archbishop of the Archdiocese of Miami, his
successors in office,a corporation sole,has made,constituted and appointed,and by these presents
does hereby make, constitute and appoint Sister Elizabeth A. Worley, C.O.O.,his true and lawful
attorney for him and in his name,place, and stead.
Giving and granting unto Sister Elizabeth A. Worley, C.O.O., his said attorney full power and
authority to do and perform all and every act and thing whatsoever requisite and necessary to be
done in and about the premises as fully, to all intents and purposes, as he might or could do if
personally present,with full power of substitution and revocation,hereby ratifying and confirming
all that Sister Elizabeth A. Worley, C.O.O.,his said attorney or his substitute shall lawfully do or
cause to be done by virtue hereof.
In Witness Whereof, I have hereunto set my hand and seal this 8 day of March, A.D., 2017.
Signed, sealed and delivered in the presence of-
Witness:
fWitness:
Witness Siknature The Most Reverend Thomas Wenski
t���j , As Archbishop of the Archdiocese of
,a 11 t '�'�� Miami his successors in office, a
Printed Name corporation sole
Witnes Signature
}Mo;,r I+2—a (-V7G 5�1 io
Printed Name
STATE OF FLORIDA )
SS:
COUNTY OF DADE )
I hereby certify that on this day,before me,an officer duly authorized to administer oaths and take
acknowledgements, personally appeared The Most Reverend Thomas Wenski, as Archbishop of
the Archdiocese of Miami, his successors in office, a corporation sole, known to me to be the
person described in and who executed the forgoing instrument,who acknowledged before me that
he executed the forgoing ins�ument,who acknowledged before me that he executed the same,and
an oath was not taken. ✓ Said person is personally known'to me -- Said person provided
the following type of identification:
Witness my hand and official seal in the County and State last aforesaid this 8 day of March,A.D.,
2017.
My Commission Expires: jj°"` " blyk swe a Fww
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CF" 2010R1041104Z7
W 54 2M As 0713, tits I
PrqwvdbyWWRW=1W IVAWM
1 NlNit{ O W"
J.PaWc k Fita$=K Esq. `A$fi —BA IAWYR FLD$jOA
J.Patrick Fhgp"&AasoaWo,P.A. PAK
110 Merrick'Way,Suite 3-B
Cont Cnbks,FL 33134
AFMAViT OF ARCHBISHOP'S SUCCESSION
STATE OF FLORIDA )
SS;
COUNTY OF MIAMI DARE )
Before me,the undersigned authority,personally appeared The Most Reverend Thomas G.WeasK
who being duly mom according to law,deposes and says as follows:
1, a that on June 1,2010,1 was installed as the Archbishop of the Archdiocese of Miami,succeeding
The Most Reverend John C.Favalora.
2. that effective June 1, 2010, 1 am the Metropolitan Archbishop of the Archdiocese of Miami
which embraces the counties of Miami-Dade,Broward and Monroe in the State of Florida
3. that pursuant to the Canon Law of the Roman Catholic Church, I have all rights of succession
to The Most Reverend John C. Favalora.
4. that under the doctrine of corporation sole,the title to all property in the Archdiocese of Miami,
which encompasses the counties of Miami-Dada,Broward and Monroe,was held by The Most Reverend John
C. Favalora, as Archbishop of the Archdiocese of Miami, his successors in office, a corporation sole,w of
December 20, 1994 through April 20,2010,and as the Apostolic Administrator from April 20, 2010 through
June 1,2010. -
5. that under the doctrine of coipmration sole,the title to all property in the Archdiocese of Miami,
which encompasses the counties of Mismi-Dade, Broward and Monroe, is held by The Most Reverend
Thomas G.Wenski,as Archbishop of the Archdiocese of Mlan4 We successors in office,a corporation
sole,as of June 1,2010.
b. That under penalties of perjury,l deckare that I have examined this certification and to the best of
my knowledge and belief it is true,correct,and complete.
FURTHER AFFIANT SAYETH NOT.
The Most Reverend Thomas G.Wensld
The foregoing instrument was acknowledgebefore tris this-, of June, 2010, by The Meg
Reverend Thomas G.Wenski. {Cleak One) els personally known to me or [ ]He has produced"
.as identification. r.ar.n■■anuu.r+a«►er �ui■
I JAWETt1 .
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1i1�'1TtlIM.�MIHMORY7�ItlfUC�D?6APpDAVR
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06!06116
W-14
Coasumer's Certificate of Exemption R.1o/15
Issued Pursuant to Chapter 212,Florida statutes
IDA _
85-80170182920-9 �ML_05/18/2016 05/31/2021 RELIGIOUS-PHYSICAL PLACE
Gertrircate N Dat® EXpWiW—Date 6c iiPum cmam
This certifies that
ARCHDIOCESE OF MIAMI INC
9401 RISCAYNE BLVD
MIAMI SHORES FL 33138-2970
Is exempt from the payment of Florida sales and use tax on real property rented,transient rental property rented,tangible
personal property purchased or rented,or services purchased.
J' jj Important Information for Exempt Organizations R.10/15
1. You must provide all vendors and suppliers with an exemption certificate before making tax-exempt purchases.
See Rule 12A-1.038,Florida Administrative Cade(FA.C.).
2. Your Consumer's Certificate of Exemption Is to be used solely by your organization for your organization's
customary nonproflt activities.
3 Purchases made by an indlvidual on behalf of the organization are taxable,even if the Individual will be
reimbursed by the organization.
4. This exemption applies only to purchases your organization makes. The sale or lease to others of tangible
personal property,sleeping accommodations,or other real property Is taxable. Your organization must register,
and collect and remit sales and use tax on such taxable transactions. Note: Churches are exempt from this
requirement except when they are the lessor of real property(Rule 12A-1.070,F.A.C.).
5 it Is a criminal offense to fraudulently present this certificate to evade the payment of sales tax. Under no
circumstances should this certificate be used for the personal benefit of any individual. Violators will be liable for
payment of the sales tax plus a penalty of 200%of the tax,and may be subject to conviction of a third-degree
felony. Any violation will require the revocation of this certificate.
61 If you have questions regarding your exemption certificate, please contact the Exemption Unit of Account
Management at 800-352-3671. From the available options,select"Registration of Taxes,"then"Registration
information,"and finally"Exemption Certificates and Nonprofit Entities." The malling address Is PO Box 6480,
Tallahassee, FL 32314-6480.
Aug 21 17 08:19p Debbie 00000 p.7
ji
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores,FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-288211 Permit Number: EL-7-17-1872
Scheduled Inspection Date:August 21,2017 Permit Type: Electrical -Residential
Inspector: Devaney, Michael
Inspection Type: Rough
Owner: MCCARTHY ARCHBISHOP,EDWARD A Work Classification: Ad ditio nWte ration
Job Address:9401 BISCAYNE Boulevard
Miami Shores,FL Phone Number
Project: <NONE> Parcel Number 1132060490010
Contractor: HAIRSTON-STEVENS ELE CONST INC Phone: (954)587-7335
Building Department Comments
REPLACE EXISTING PARKING LOTTO LED LIGHTING Passed Comments
WITH SAME EFFECT INSPECTOR COMi1lIENTS False
Inspector Comments
Passed [LET
� � 7
Failed < yL tv( a- I
Correction
Needed a �.
Re-inspection �a
Fee
No Addlilonal Inspect;ons can be scheduled until
re-inspeClon fee Is paid.
August 18,2017 For Inspections please call: (305)762-4949
Page 25 of 28
Aug 21 17 08:19p Debbie 00000 p.6
r/
Certification of Compliance with Parking Lot Illumination
Standards in Chapter 8C of the Code of Miami-Dade County
Date: kj ( S ,zo t 7
Property Address: 9401 BISCAYNE BLVD, MIAMI SHORES, FL 33138
Folio No.: 11-3206-049-0010
Building Description: ADOM PASTORAL CENTER
Bldg.:
The undersigned states the following:
1. I am a Florida registered professional engineer or architect with an active license.
2. On ��k„s� l�t z(> t-7 , 20 D, I measured the level of illumination in the parking
lot(s) serving the above referenced building.
3. Maximum 13-0 foot candle per SF,
Minimum •32 loot candle per SF,
Maximum to Minimum ratio 2.4 .1.1 , foot candle 2.92 average per SF.
4. The level of illumination provided in the parking lot "✓°` meets does not meet the
minimum standards for the occupancy classification of the building as established in Section
§8C-3 of the Code of Miami-Dade County.
'tqS
and al o Print lame
al Engineer or Architect _
-
........ _. . _..
-.. ............................. --- - _ _. _..... .._RevisedAugust 2014
itNO- EL872
Miami Shores Village Pp ryg:T'ype:Electrical-lkliiiondal
10050 N.E.2nd Avenue
r 0e, 1 � tassnication-ACfdltiion/A "' 00t1..
•••• Miami Shores,FL 3313&0000 PenWt Status.APPRC?�6
Phone: (305)795-2204
Issuei a :� 134 017 Expiration: 0 1/27/2018
Project Address Parcel Number Applicant
9401 BISCAYNE Boulevard 1132060490010
Miami Shores, FL Block: Lot: EDWARD A MCCARTHY ARCHB
Owner Information Address Phone Cell
EDWARD A MCCARTHY ARCHBISHOP
FL
Contractor(s) Phone Cell Phone
Valuation: $ 2,400.00
HAIRSTONSTEVENS ELE CONST INC (954)587-7335 Total Sq Feet: p
Type of Work:REPLACE EXISTING PARKING LOT TO LED Available Inspections:
Additional Info:REPLACE EXISTING PARKING LOTTO LED Inspection Type:
Classification:Residential Final
Scanning:3 Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Review Electrical
Review Electrical
W.W.
Underground
Fees Due Amount Pay Date Pay Type Amt Paid Amt Due
CCF $1.80 Invoice# EL-7-17-64650
DBPR Fee $5.27 07/31/2017 Credit Card $325.34 $50.00
DCA Fee $5.27
Education Surcharge $0.60 07/20/2017 Credit Card $50.00 $0.00
Permit Fee-Additions/Alterations $351.00
Scanning Fee $9.00
Technology Fee $2.40
Total: $375.34
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 zoning. u I authorize the bove-named contractor to do the work stated.
July 31,2017
Author' ignat e:0 / Applicant / Contractor / Agent Date
Building Department Copy
July 31,2017 1
Itelecom USA Purchase Order
14333 Commerce Way
Miami Lakes,FL 33016 Date P.O. No.
7/24/2017 2126521
Vendor Ship To
HAIRSTON/STEVENS ELECTRICAL CONTRACTORS, ADOM Pastoral Center
Jim Hairston 9401 Biscayne Blvd
1520 NW 65th Ave. Miami Shores,FL
Plantation,FL 33313
Item Description Qty Rate Amount
GO+ REPLACE EXISTING POLE MOUNTED 250 HID 25 75.00 1,875.00
LUMINAIRES WITH NEW 80 WATT LED
GO+ REPLACE EXISTING CEILING MOINTED CANOPY 6 87.50 525.00
175 HID LUMINAIRES WITH NEW 45 WATTS LED
FIXTURES
0
Total $2,400.00