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DEMO-15-2341 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-243502 Permit Number: DEMO-9-15-2341 Scheduled Inspection Date: September 28, 2015 Permit Type: Demolition Inspector: Devaney, Michael Inspection Type: Final Owner: , Work Classification: Electric Job Address:9055 BISCAYNE Boulevard Miami Shores, FL 33138- Phone Number Parcel Number 1132060110051-55 Project: <NONE> Contractor: QUALITY FIRST ELECTRIC SWFL CORP Phone: (877)881-0084 Building Department Comments ELECTRICAL WORK FOR INTERIOR DEMO Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-inspection ❑ Fee No Additional Inspections can be scheduled until re inspection fee is paid. September 25, 2015 For Inspections please call: (305)762-4949 Page 23 of 39 Miami Shores Village =BY: 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 FBC 20/y BUILDING Master Permit No./ ,f204 /-L— 22917 PERMIT APPLICATION Sub Permit No.D!!? /,,57-- 231-1 ❑BUILDING M ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 9055 Biscayne Blvd. City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated:Yes NO X Occupancy Type: M Load: 345 Construction Type: 11 Flood Zone: BFE: FIFE: OWNER:Name(Fee simple Titleholder): IMC Property Management & Maintenance Phone#:305-893-9955 EXT-107 Address:696 N.E 125 Street North Cit,: Miami State: Florida Zip: 33161 Tenant/Lessee Name: Dollar Tree Stores Phone#:757-321-5218 Email: cgomez@dollartree.com CONTRACTOR:Company Name: Quality First Electric SWFL, Corp. Phone#: 877-881-0084 Address: 17011 Alico Commerce Ct. Unit 506 City: Fort Myers state: Florida Zip: 33967 Qualifier Name: Anotonio Nieto Phone#: 239-287-0827 State Certification or Registration#: EC0000992 Certificate of Competency#: DESIGNER:Architect/Engineer: RRMM Architects Phone#: 757-622-2828 Address: 1317 Executive Blvd. Suite 200 Cit,: Chesapeak State: VA Zip: 23320 Value of Work for this Permit:$2,800 Square/Linear Footage of Work: 12,477 Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ■❑ Demolition Description of Work: E( LT'tZ 1<=A L- tL5 ID PL t/-- �1^OfZ— )D M� Specify color of color thru tile: Submittal Fee$ Permit Fee$ 4V CCF$r CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ 2 TOTAL FEE NOW DUE$ J 0 (Revised02/24/2014) Bonding Company's Name(if applicable) N/A Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zips Application is hereby made to obtain a permit to do the work and installations as indicated. I certifylthat no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the iandards 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..... i 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 PROOERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORN9Y 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 commencemeht 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. Pre Signatu r< OWNER or AGENT CO ACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was ac Inowledged before me this day of��PrZ-iiNJ0E?� ,20 /S bynn� day of °Z 20 �� by 0,0e- who ispersonallV known to /il 76AI/a NfTv ;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. IWPU C: NOTARY PUBLIC: 7 Sign: Sign: 0:���} Print: t7 Print: [ L `/G°7 Seal: Y P e Seal: -40PC& N ry Public Stats of Florida °S c LUCY CICILIO * MY COMMISSION p EE 164923 Phan �f+ My Commission FF 232517 EXPIRES:April 19,2016anP' Ex 'res 05119/2019 APPROVED BY / Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) '`y1pNE awe* ..... + Miami shores Village y , #yam wilding Department 0 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTMTION FOR ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A$30.00 FEE PER YEAR, IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. /COPY OF QUALIFIER'S STATE LIC CARD B. PY OF LOCAL BUSINESS TAX RECEIPT C. OPY OF LIABILITY INSURANCE(CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPT) D. vCPOPY OF WORKERS COMPENSATION{EITHER CERTIFICATE OR ECEMPTION) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT C. COPY OF LIABILITY INSURACE(CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPT) D. COPY OF WORKER COMP INSURANCE(EITHER CERTIFICATE OR EXEMPTION) YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 ram®■e�s�r��ya�����r��nrr�rra■■err�ds�rwnras*srtaa�����a��rr�rrrAsasa■rsEw�� t+xw®arrrwpw�sreq�e COMPLETE CONTRACTOR'S INFORMATION BUSINESS NAME: r°' ~- 7,CNP . BUSINESS ADDRESS: -CITY UvZSTATEZIP CODE BUSINESS PHONE: ) Kol FAX NUMBER I CELL PHONE( } QUALIFIER'S NAME: QUALIFIER'S LIC NUMBER: - E•MAIL ADDRESS(IF APPLICABLE): Created on 3H 9109 BY MLDV i RV 3126109 MLDV STATE O I DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION R ELECTRICAL CONTRACTORS LICENSING BOARD (350)437-139 1940 NORTH MO ROE STREET TALLAHASSEE FL 32399-0783 NIETO,ANTONIO QUALITY FIRST ELELCTRIC SWFL CORP 5901 SSV 93RD PLACE MIAMI PL 33173 Congratulations! Vt/ith this license you become one of the nearly -----< one million Floridians licensed by the Department of Business and Professional Regulation, Our professionals and businesses range STATE OF FLORIDA from architects to yacht brokers from boxers to barbeque restaurants, DEPARTMENT'ARTMENT OF BUSINESS AN and they keep Florida's economy strong. ,wr Y PROFESSIONAL-REGULATION Every day we work to improve the way we do business in carder to ECIXg692 ISSUED 07/0712014 serve you better. For information about our services,please log onto www.myfloridalicense.com. There you can find more information CERTIFIED ELECTRICAL GONTl 'a TC R about our divisions and the regulations that impact.you,;subscribe NIETPO,ANTr3NfO to department newsletter's and(earn,more about the Department's t3ALlT FIRST ELEi CT3 lC S 1FL CORP initiatives_ Our omission at the Department is:License Efficiently,Regulate Fairly- We constantly strive to serve you better so haat you can serve your oustorners_ Thank you for doing business in Florida, is CERTIFIED Under the ProvisiOrss Of C"" FS. and congratulations on your new license' DETACH HERE RICK SCOTT,GOVERNOR KEN L.AWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL SSIONAL RE UL AT ON ELECTRICAL CONTRACTORS LICENSING BOARD4 _ ys Cf3Qtlgg2 The ELECCTRiCAL CO T ACTO Named below IS CERTIFIEL? Under the provisions of Chapter 489 FSS_ Expiration data. AUG 31,2016 NJE `O,ANTONIO QUALITY FIRST ELELCTRIC BNFL CORP 970a IEST TERRY ST SOI`I'A SPRINGS FL 34135 � Q I SUED: 07/07j2014 DISPLAY AS REQUIRED BY LAW SEQ# L.14079-70001153 SU000,123 Lee County Tax Collector TaA tor 2480 Thompson Street X CFort Myers, Florida 33901 NVwww.leetc.com Tel: 239.533.6000 I. Local Business Tax Account: 0901741 Dear Business, Owner- Your 2014-2015 Lee County Local Business Tax Receipt is attached below. The receipt is non- regulatory and is issued using the information Currently on file with our office. It does not signify compliance with zoning, health or other regulatory requirements nor is it an endorsement of work quality. Annual account renewal notices are mailed in August to the address of record at that time; to ensure delivery Of Your annual notice, mailing addresses may be updated online at www.leetc.com. If there is a change in the business name, ownership, physical location or if the-business is being closed, please follow the instructions on the back of this letter to transfer or to close the account. I hope you have a successful year. Lee County Tax Collector Delach and display tofforri portico and keep upper portion for your records 'Pe LEE COUNTY LOCAL BUSINESS ITAX RECEIPT Ila tor 2 014 - 2015 A. ACCOUNT NUMBER. 0901741 ACCOUNT EXPIRES SEPTEMBER 30, 2015 of May engago ira-the business of-- Location CE CERTIFIED ELECTRICAL CONTRACTOR 9768 WEST TERRY ST BONITA SPRINGS FL 34135 THIS LOCAL BUSINESS TAX RECEIPT IS NON REGULATORY QUALITY FIRST ELECTRIC SWFL GONE' NIETO ANTONIO TMS IS NOT A BILL-DO NOT PAY 9768 WEST TERRY ST BONITA SPRINGS FL 34135 PAID 361581-25-1 08/26/2014 M44 WEB $50.00 •� CERTIFICATE OF LIABILITY INSURANCE DAT091101D#15 €�#/1 t3I2C?15 THIS CERTIFICATE IS ISSUED AS A MATTER OF 1NFORMA'CION ONLY AND CONFERS NO km-HTS 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 certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. H SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificateholder in lieu of such endorsement(s). ..-1..-11-- _....._._... . .. .............. PRODUCER _. CONTACT..._.. .._._ William Preissel Ord Agencies LIc —ALPADHrO—DRNEE -239)498 9909 FAX .� 8840 Terrene Ct,Suite 103 E-MAIL,Exit ( ..__ .. art ... (+�C NA) {�39}498 9791 MAIL _ Pre)ssei hfink.naI Bonita Springs,FL 34135 INSURERS)AFFORDINt#COVERAGE MAIC X _ _. _ Phone (239)498-9909. Fax...........(239)498-9791 INSURER A North Pointe Ins,Co. _ ---- - _...... ... .... ........ INSURED -.. _.. _ INSURER B, RetailFirSt Quality Firs Ferric,SW FL,Corp, INSURER c Allied Property and Casualty Insurance Company - ..-- - _ 17011 Alico Commons Ct #506 IN§URER o Fort Myers FL 33967 ; INSURER_E'.._ _ INSURER F' — _ _...._. __ .._.__. _ COVERAGES CERTIFICATE NUMBER: EC�92 REVISION NUM_BER. THIS IS 70 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 WITH 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, j EXCLUSIONS AND CONDITIONS OF SUCH POLICIES .. REDUCED !NSR ADDL�UBR __ . TYPE OF INSURANCE lXtYt2 POLICY NUMBER POLICY EFF POLY EXP �tMRolPrrY� E�raicwmYY1_. -. .. _. ..... LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000.00 r®� COMMERCIAL GENERAL LIABILITY � bAmAGE Y Aff- b 1 00 0w.00 ❑ ❑ CLAIMS-MADE ® OCCUR PREMISES(En occurrence} S MED EXP(Anyone person) s 5,0OO.OD A ; Y N 18090015619 ?0210812015 ,02/08/2016 PERSONAL ADV' — - ---_ .. ❑ INJURY S 1,000.00000 ❑ GENERAL AGGREGATE S 2,000,000.00 E3EN'L AGGREGATE LIMIT APPLIES PER I PRODUCTS-COMP/OP AGC S 2,000,000.00 000 ® POLICY ❑ ❑ LOC... .._... PRO _IEOT._.._.... b AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accldar ij $ ❑ ANY AUTO I BODILY INJURY(Pea ❑ ALL OWNED SCHEDULED AUTOS ❑ AUTOS I BODILY INJURY(Per acxu3ant); $� © HIRED AUTOS ❑ AONOOWNEF? � ) AGE� PROPERTY -- $ _ AM {?er aeadeni�_ ❑ _._.....__ ._ S ❑ UMBRELLA LIAR F1OCCUR R HRRE._ ❑ EXCESS LtAB ❑CLAIMS-MRDE AGGREGATE NCE _I0_�_. ETENTICTN$ S WORKERS COMPENSATION _ _.__. PER M ETH AND EMIPLOYERS'LIABILITY _ YtN = ANY PROPRIETORIPARTNERIEXECUTIYE i EL EACH ACCOENT $ 1 000 00000 B t acERn�EMBER FxcLUOEo N JAZ N 10520 008273 ppW 0412712015 '04127'12016 (Mandatory#ttN#� E.L.DISEASE-EAFMPLOYE S 1,0�,(I00.00 - If yes,describe under 1,000,000,00 , 3 DESCRIPTION OF OPERATIONS wow E L DISEASE POLICY LIMIT 3 { I C Bond (BD7900683419 01/3112015 1 0151 P2016 5,000 j I DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD tut,Additional Remarks Schedule,if more space Is required) The Certificate Holder is named as Additional Insured. ECO000992 I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Department I THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 10050 N.E,2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores,Florida 33138 # __ j At D REPRESi?NTAT'�E ,,t'`" j Tel (305)795.2204 Fax_(305)756.8972 1988 2014 ACORD CORPORATION.. All rights reserved. ACORD 26(2014/01)OF The ACORD name and k90 are registered varlts of ACORD NVP tis�!p' rpt Miami Shores Village Iy#tQ Ilt�o 10050 N.E.2nd Avenue \ ° Cj holt trlC Miami Shores,FL 33138-0000 Phone: (305)795-2204 +t'. I \\ �coRsin �' Expiration: 03/19/2016 Project Address Parcel Number Applicant 9055 BISCAYNE Boulevard 1132060110051-55 SHORE SQUARE PROPERTIES I Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell SHORE SQUARE PROPERTIES LLC 9055 BISCAYNE BLVD. L�j Contractor(s) Phone Cell Phone Valuation: $ 2,800.00 QUALITY FIRST ELECTRIC SWFL COI (877)881-0084 Total Sq Feet: 12477 Type of Demo:Electric Available Inspections: Additional Info:ELECTRICAL WORK FOR INTERIOR DEMO Inspection Type: Classification:Residential Final Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# DEMO-9-15-57088 DBPR Fee $2.25 DCA Fee $2.25 09/21/2015 Credit Card $ 118.30 $50.00 Education Surcharge $0.60 09/15/2015 Check#:2174 $50.00 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $2.40 Total: $168.30 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,PLUMB NG,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFI VIT: I rti at XI the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construc n an nin . uth o I authorize t e above-named contractor to do the work stated. September 21, 2015 Aut orized SignatuAW-(5wner / Applicant / Contractor / Agent Date Building Department Copy September 21,2015 1