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MCC-18-3641Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Permit NO.: MCC-12-18-3641' LI Permit Type: Mechanical - Commercial > � q Work Classification: Alteration Permit Status: Approved Issue Date:12/12/2018 Expiration:06/10/2019 Location Address Parcel Number 9050 BISCAYNE BLVD, Miami Shores, FL 33138 1132060100010 Contacts PUBLIX SUPERMARKETS, INC Owner PUBLIX SUPERMARKETS, INC Applicant PUBLIX SUPERMARKETS, INC PUBLIX SUPERMARKETS, INC P 0 BOX 407, LAKELAND, FL 338020407 P O BOX 407, LAKELAND, FL 338020407 Other:863688747 Other:863688747 EXCELL REFRIGERATION INC Contractor RAYMOND TAYLOR 605 WHITNEY AVE, LANTANA, FL 33462 Business: 5615850342 Description: WORK AS PER MASTER CC18-902. CHANGE OUT Valuation: $ 322,545.91 Inspection Requests: 305-762-4949 EXISTING CASES. INSTALL NEW REFRIGERATION PIPING & CHANGEOUT EXISTING WALK-IN COOLER COILS. Total Sq Feet: 19,700.00 Fees Amount Application Fee - Other $50.00 CCF $193.80 DBPR Fee $145.15 DCA Fee $96.76 Education Surcharge $64.60 Permit Fee $9,626.38 Scanning Fee $3.00 Technology Fee $241.91 Total: $10,421.60 Payments Date Paid Amt Paid Total Fees $10,421.60 Credit Card 12/10/2018 $50.00 Credit Card 12/12/2018 $10,371.60 Amount Due: $0.00 Building Department Copy 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 rmore, I authorize the above named contractor to do the work stated. Authorized Signature: Owner / Applicant / Contractor / Agent Date December 12, 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 FBC 20 1- Master Permit No. C�C-4-18-902 Sub Permit No. 1 " lCj ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑■ MECHANICAL ❑PUBLIC WORKS [:]CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9050 BISCAYNE BLVD City: Miami Shores County: Miami Dade Zip: 33138 Folio/Parcel#:1132060100010 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple Titleholder): NORTHERN TRUST BANK ETAL TRS % PUBLIX SUPERMARKET INC Phone#: Address: PO BOX 32025 City: LAKELAND State: FL Zip: 33802 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: EXCELL REFRIGERATION Phone#: 561-585-0342 Address: 2010 SEABIRD WAY City: RVIERA BEACH State: FL Zip: 33404 Qualifier Name: RAYMOND TAYLOR Phone#: 561-585-0342 State Certification or Registration #: CACO22413 Certificate of Competency #: DESIGNER: Architect/Engineer: hone#: Address: City: State: Zip: Value of Work for this Permit: $ 322,545.91 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑■ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: WORK AS PER MASTER #CC-4-18-902. CHANGE OUT EXISTING CASES. INSTALL NEW REFRIGERATION PIPING & CHANGEOUT EXISTING WALK-IN COOLER COILS. Specify color of color thru tile: Submittal Fee $ V Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ 11 DBPR $ _ CO/CC $ Notary Double Fee $ Bond $ TOTAL FEE NOW DUE $ (Revised02/24/2014) Bonding Company's Name (if applicable) Bonding Company's Address N/A City State _ Mortgage Lender's Name (if applicable) N/A 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. Signature Signature OWNER or AGENT CTOR The foregoing instru n was acknowledged before me this day of 20 I C by who is personally known to me or who has produced as identification and who did take an oath. NOTARY BLIC: Sigrr �, Print: — ` ,X) V1 In 0 Seal. rot yP&*, DONNETTLOWE * * MY COMMISSION # GG VA162 ra oe EXPIRES: December 1Z 2020 �OF F104`� Bonded T- BudW Notary $«yam= The foregoing instrument was acknowledged before me this I day of 20 l'S by '1�dL�xL who is pe sonally k wn to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print: nVVUg+ L Sea]: A" '*3, DOMINIK SWABY MY COMMISSION # GG51352 � e EXPIRES: December 13, 2020 as \ � v APPROVED BY V\,�'` Plans Examiner Zoning Structural Review Clerk (Revisec102/24/2014) Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. X COPY OF QUALIFIER'S STATE LICENCES B. X COPY OF LOCAL BUSINESS TAX RECEIPT C. X COPY OF LIABILITY INSURANCE* D. X COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. ............................................................................................ BUSINESS NAME: EXCELL REFRIGERATION BUSINESS ADDRESS: Z0I0 5EANRP WAY BUSINESS PHONE: 5( (0I ) r2gr1'O-j42 CITY RIVIERA BEACH STATE rL ZIP 33404 FAX NUMBER ( %I) r247-OO& J CELL PHONE ( r2* SS��o34Z QUALIFIER'S NAME: RAYMONP TAYLOR QUALIFIER'S LIC NUMBER: CACOZ24I3 s RICK SCOTT, GOVERNOR STATE OF FLORIDA DEPARTMENT OF BUSINESS. -AND -PROFESSIONAL REGULATION CONSTRUCTION it . DU{STRY ]CEN, SING BOARD T. THE CLASS A AIR CONDITIONING CONTRACTOR HEREIN, r1S;,CERTIFIED UNDER THE JONATHAN ZACHEM, SECRETARY SIONS OF,CHAPT -R-489,-FLORI ► = A; s •r • .:.ti},�1�!,y'r" "7 nip r-tr-_'y EXC X6REFRIGERATJQN�INC "# ,� 4 ,2QV61SEABIRD � -Ay -- 4 jRIVIERA'BEACH Fl-,3,340+4, � r EXPIRATI0f*DAT.&-7AUGUST 31, 2020 Always verify licenses online at MyFloridaLicense.com o,a Do not alter this document in any form. This is your license. It is unlawful for anyone other than the licensee to use this document. u�p ANNE_ M. GANNON CONSTITUTIONAL TAX COLLECTOR Ser"iug Palm Beach County Serving you, TYPE OF BUS,NES— S 23.0001 CW AIR CONDITIONING CONTRACTOR P.O. Box 3353, West Palm Beach, FL 33402-3353 www.pbctax.com Tel: (561) 3�5-2264 "LOCATED AT" OWNER TAYLOR RAYMOND LESLIE This document is valid only when receipted by the Tax Collector's Office. 2010 SEABIRD WAY RIVIERA BEACH, FL 33404 CERTIFICATION # RECEIPT igDATE PAID AMT PAID BILL # CACO22413 U18681q Og�9pi,p $i°a +fa I 840101421 STATE OF FLORIDA BEACHPALM EXCELL REFRIGERATION INC 82 1134 2018/2019 LOCAL BUSNESS TAX RECEIPT EXCELL REFRIGERATION INC 2010 SEABIRD WAY LBTR Number: 199902712 RIVIERA BEACH, FL 33404 EXPIRES: SEPTEMBER 30, 2019 This receipt grants the privilege of engaging in or managing any business profession or occupation within its jurisdiction and MUST be conspicuously displayed at the place of business and in such a manner as to be open to the view of the public. Y.` A_NNE M. GANNON lT CONSTtTUT10NAL TAX COLLECTOR Serving Palm Beady Coenry Serving you. TYPE OF BUSINESS 23-0148 AIR CONDITIONING CONTR P.O. Box 3353, West Palm Beach, FL 33402-3353 "LOCATED AT" www.pbctax.com Tel: (561) 355-2264 2010 SEABIRD WAY RIVIERA BEACH, FL 33404 OWNER TAYLOR RAYMOND LESLIE This document is valid only when receipted by the Tax Collector's Office. EXCELL REFRIGERATION INC EXCELL REFRIGERATION INC 2010 SEABIRD WAY RIVIERA BEACH, FL 33404 CERTIFICATION# I RECEIPT #/DATE PAID AMT PAIDI BILL # CACO22413 I U18.681364-08R8/18 S59 50 840101420 STATE OF FLORIDA PALM BEACH COUNTY B3 - 1134 2018/2019 LOCAL BUSINESS TAX RECEIPT LBTR Number: 199902713 EXPIRES: SEPTEMBER 30, 2019 This receipt grants the privilege of engaging in or managing any business profession or occupation within its jurisdiction and MUST be conspicuously displayed at the place of business and in such a manner as to be open to the view of the public.