ELC-18-3594Miami Shores Village
10050 NE 2 Ave
Miami Shores FL 33138
305-795-2204
Issue Date:12/11/2018
Location Address Parcel Number
9050 BISCAYNE BLVD, Miami Shores, FL 33138 1132060100010
Contacts
Permit NO.: ELC-12-18-3594
Permit Type: Electrical - Commercial
Work Classification: Alteration
Permit Status: Approved'
Expiration: 06/03/2019
PUBLIX SUPERMARKETS, INC Owner PUBLIX SUPERMARKETS, INC Applicant
PUBLIX SUPERMARKETS, INC PUBLIX SUPERMARKETS, INC
P 0 BOX 407, LAKELAND, FL 338020407 P 0 BOX 407, LAKELAND, FL 338020407
Other:863688747 Other:863688747
C DAVIS ELECTRIC COMPANY, INC Contractor
CHARLES DAVIS
Business: 9544324334
Description: ELECTRICAL FOR STARBUCKS AT PUBLIC 794. Valuation: $ 37,900.00 Inspection Requests:
305-762-4949'
Total Sci Feet: 791.00
�j -� - - — — ----- - ------ ---
Fees
Amount
Application Fee - Other
$50.00
CCF
$22.80
DBPR Fee
$17.06
DCA Fee
$11.37
Education Surcharge
$7.60
Permit Fee
$1,087.00
Scanning Fee
$3.00
Technology Fee
$28.43
Total:
$1,227.26
Building Department Copy
Payments Date Paid
Amt Paid
Total Fees
$1,227.26
Credit Card 12/04/2018
$50.00
Check # 75343 12/11/2018
$1,177.26
Amount Due:
$0.00
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
re t' co struction and zoning. Futhermore, I authorize the above named contractor to do the work stated.
Pa, Qe-rlil—d
Authorized Signature: Owner / Applicant / Contractor / Agent Date
December 11, 2018 Page 2 of 2
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
BUILDING
PERMIT APPLICATION
❑BUILDING ❑■ ELECTRIC ❑ ROOFING
DEC b 4 318
4wil
Master Permit No.CC-8-18-2224 1
Sub Permit No. le I - 3s'�
❑ REVISION ❑ EXTENSION [:]RENEWAL
PLUMBING ❑ MECHANICAL [:]PUBLICWORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 9050 BISCAYNE BLVD
City: Miami Shores County: Miami Dade Zip: 33472
Folio/Parcel#: 11 -3206-010-0010 Is the Building Historically Designated: Yes NO
Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE:
OWNER: Name (Fee Simple Titleholder): PUBLIX SUPERMARKETS INC. Phone#: 863-688-1188
Address: 3300 PUBLIX CORPORATE PKWY
City: LAKELAND
Tenant/Lessee Name:
Email:
State: FL
hone#:
P: 33811
CONTRACTOR: Company Name: C. DAVIS ELECTRIC CO. INC Phone#: 954-432-4334
Address: 1701 SW 100 TERRACE
City: MIRAMAR State: FL Zip: 33025
Qualifier Name: aav flee f - p4✓ tS if- Phone#: 954-275-6004
State Certification or Registration #: C - Uo D I o3 8 Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State:
Value of Work for this Permit: $ 37,900 Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑■ Alteration ❑ New ❑ Repair/Replace
Description of Work: SUB ELECTRICAL FOR STARBUCKS AT PUBLIX 794 �.
Specify color of color tl�ru tile:
Submittal Fee $ Sty AIV Permit Fee $ 3 y CCF $_
Scanning Fee $ Radon Fee $ 11 DBPR $
Technology Fee $ Training/Education Fee $
Structural Reviews $
Zip:
❑ Demolition
CO/CC $
Notary $
Double Fee $ _
Bond $
TOTAL FEE NOW DUE $ 17P , 2,0
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
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.
�W* F_
Signature
OWNER or AGENT
The foregoing instrument was acknowledged before me this
day of20 L, by
�1L�QP� 7� r who personally know to
me or who has produced
as
Signature
CONTRACTOR
The foregoing instrument was acknowledged beforemethis
20 day of fe�.�C�, 20 I o by
aC'ile5 E DAv'S Jr who' ersonallyknownto
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
Print: 3D\C-
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Print:
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Seal:
Seal:
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DOUGLAS E. BERNARD, SR.
DUNA SHECKLER=
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Commission # FF 899572
Expires July 14, 2019
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Commltelon N DG 230 606
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APPROVED BY
L!
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)