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EL-17-1641 Permit NO. EL-6-17-1641 Miami Shores Village Permit Type:Electrical-Residential 10050 N.E.2nd Avenue NE WoricClassifrCation Alarm Miami Shores,FL 33138-0000 Per Phone: (305)795-2204 Permit Status:APPROVED f'CORIDp' Issue ate:M2/2017 Expiration: 01/08/2018 Project Address Parcel Number Applicant 1420 NE 103 Street 1132050310030 Miami Shores, FL Block: Lot: MARC AND ANNE LITZENBERG Owner Information Address Phone Cell MARC AND ANNE LITZENBERG 1420 NE 103 Street MIAMI SHORES FL 33138- 1420 NE 103 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 2,460.00 RELATED SYSTEMS INC Total Scl Feet: 0 Type of Work:BURGLAR ALARM SYSTEM Available Inspections: Additional Info: Inspection Type: Classification:Residential Review Electrical Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.80 Invoice# EL-6-17-64382 DBPR Fee $2.00 DCA Fee $2.00 06/22/2017 Credit Card $50.00 $67.80 Education Surcharge $0.60 07/12/2017 Credit Card $67.80 $0.00 Permit Fee-Additions/Alterations $100.00 f Scanning Fee $9.00 Technology Fee $2.40 Total: $117.80 i 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: hat all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction zonin h m re,I authori a the above-named contractor to do the work stated. July 12, 2017 Authorized Signature:Owner / Applicant / Contractor / Agent Date Building Department Copy July 12, 2017 1 Miami Shores Village RECEIVED Building Department JUN 2 21017 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 201 BUILDING Master Permit No. �. — PERMIT APPLICATION Sub Permit No.,Ln ❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS [:] CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: ` _ 3 ZOS D 3/—z?o 3o Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construc�ion Type: Flood Zone: BFE: FFE: OWNER: Name,,(Fee Simple Titleholder): I"btt�--G A E_ U+ -xFj�+� � cone#: /5 " Address: ( l 220 tj .iG- . i 3Si 3� City: " I A-M ( �1O!�f� State: Tenant/Lessee Name: Phone#: Email: , / . � CONTRACTOR:Company Name: FZF_�F'� S�)�i s 1 A) L . Phone#:7-S,o5�-715S-7766 Address: i s�,, L..�J 2 LQ�} e ) City: H( I1�Sttaate: �-� Zip: ��7- Qualifier Name: Z[7/U la'L� G_ !�t , � Phone#:30.�78� Y 7647 State Certification or Registration#: ���lc��f� 40 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ O Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: Specify color of color thru tile: Submittal Fee$ S�" Permit Fee$ ©®tD'P CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ 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 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 r spection fee will be charged. Signat Signature NT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of \ju nq— 120 19 by LA0 dayof JU�Q. 20 1-1 by Aorta. f rancpf SP " J�ho is personally known to who i ersonally known me or who has produced�Vt DV,2i(Ias me or who has produced as �1 identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: n 'l Sig Sign: Print: Print: Seal: C-mi, ,t►'js':^ SARANAMADO Seal: ` "'se's tN*q DOE7�IRES.My 21,2020 �; ° �WCOMMUNIFFOrio ,2= ?� Baidod Thu Nolmy PuWc Widennl(ers «,,• Ty� ************ APPROVED BY J ��.}kx-l� Plans Examiner Zoning i Structural Review Clerk (Revised02/24/2014) i `5gvs�S Grt �t.ee sellMiami a hores Village - �� Building Department A oRNp` 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax: (305)756.8972 Notice to Owner — Workers" Compensation Insurance Exemption •� Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Stat. § 440.05 allows corporate officers in the construction industry to exempt themselves from this requirement for any construction project prior to obtaining a building permit. Pursuant to the Florida Division of Workers' Compensation Employer Facts Brochure.- An rochure:An employer in the construction industry who employs one or more part-time or full-tune employees,including the owner,must obtain workers' compensation coverage. Corporate officers or members of a limited liability company (LLC) in the construction industry may elect to be exempt if: 1. The officer owns at least 10 percent of the stock of the corporation,or in the case of an LLC,a statement attesting to the minimum 10 percent ownership; 2. The officer is listed as an officer of the corporation in the records of the Florida Department of State,Division of Corporations;and i 3. The corporation is registered and listed as active with the Florida Department of State,Division of Corporations. No more than three corporate officers per corporation or limited liability company members are allowed to be exempt. Construction exemptions are valid for a period of two years or until a voluntary revocation is filed or the exemption is revoked by the Division. Your contractor is requesting a permit under this workers' compensation exemption and has acknowledge that he or she will not use day labor,part-time employees or subcontractors for your project.The contractor has provided an affidavit stating that he or she will be the only person allowed to..work on your project.In these circumstances,Miami Shores Village does not require verification of workers'compensation insurance coverage from the contractor's company for day labor,part-time employees or subcontractors. BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ THIS NOTICE AND UNDERSTAND ITS CONTENTS: Signaturl%� Owner State of Florida County of Miami-Dade The foregoing was acknowledge before me this 1 1 day of U ,20 BY MQrC 1,ItZ_2h bU'DI who is personally known to me or has produced Valid L L 32S- 5,ro -0 AgiLt'i)fication. Notary: 1 SMML11 SEAL: R ; WCOMIISSKdBoned nn NaWy R E L. AY E 0 Lr S Y S T E M S 44*7 Date 2.017 State ofLon���a County of Before me this day persomally appeared ��1 �}��ks'l� who, being duly sworn, Deposes and says: That he or she will be the only person working_on theaproje located at: Contractor signature Sworn to (or affirmed) and subscribed before me this day of U,A 20 By ���Id �c�Grns Personally know V OR Produced Identification ``NlrA. y 11(VYIAYVV •T� W10N� Type of identification produced �+ti�d� o�ABOfdld 11YU NdNy PLIC IhldenrrlbeNs Print, Type or Stamp Name of Notary Installing alarm systems since 1985 7152 Laurel Lane Miami Lakes, Florida 33014 W W W . R E L A T E D S Y S T E M S . N E T FLORIDA S T ATE LICENSE # E 0 0 0 0 0 1 04 STATE OF FLORIDA _ DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION f ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487-1395 2601 BLAIR STONE ROAD TALLAHASSEE FL 32399-0783 ADAMS, RONALD CARL RELATED SYSTEMS INC 7152 LAUREL LANE MIAMI LAKES FL 33014-2664 Congratulations! With 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 R STATE OF—,FLORIDA* from architects to yacht brokers,from boxers to barbeque ":DEPARTMENT OF;:BUSINESS AND restaurants,and they keep Florida's economy strong. :t� f-.—PROFESSIONAL-REGULATION . -- Every day we work to improve the way we do business in order ----EG0000104 ISSUED 07/1072016 - to serve you better. For information about our services, please �F„� .� ' log onto www.myfloridalicense.com. There you can find more CERT AL'ARM'SYSTEM;GONT,RACTOR-II w µ information about our divisions and the regulations that impact '" MS,RONALD'C ADAAFU""""} you,subscribe to department newsletters and learn more about Y P RELATED SYSTEMSINC� - the Department's initiatives. ' Our mission at the Department is: License Efficiently, Regulate Fairly.We constantly strive to serve you better so that you can . i -" serve your customers. Thank you for doing business in Florida, �S GERTIF1 Drunder the Provis��ons,or.ci,.aes�Fs--- and congratulations on your new license! ExPinicwndal�UG31:�201b, ===.: -L1607100001932- DETACH HERE - = RICK SCOTT, GOVERNOR- ._.- - z KEN LAWSON, SECRETARY " - i w .� " -• STATE M � � DEPARTMENT OF BUSINESS AND-PROFESSIONAL,REGULATION-,`` ELECTRICAL CO NTRACTORS43CENSING BOARD , » :'w•, ,'•�., ..... ..--."'" -....._. .-'/`..,,^—•• ..."""""'",..«."_, ^w h ^`^... '..�� Off_^`+- `'ti�',.�0.. "`4�� 'l �+. ' ''y-,�f f"'FrEG0000104...•✓ ,,.�-"_.------'---n��_..--"""-.°`"_"""'^`„�`"`"�,"o.."""..'� ��` ~w-..�.\�l'"�'``�.\�'^����"-�'',�.``r,'"" "°•'`�, S _ T1161A -ARM SYS fEM CONTRACT OR-II ' " Named below 1S CERTIFIED � -Onde,the�provislons'of C-hapter•489-FS."- 'Ex iration`date..AUG.31"2018Poo WVZ`�A�&MS;RONALD CARD—; REL'X tb -SYSTEMS-INC, —7-152 L'AUREL'LANE ��!\"AIANII�L-AKES;,,�"`"�FL'33014 2664 �'""�`�'���"``"`W"'t °•,,;`�, ,�.,g ti � t b ` �4 R fi�r� ,•*..��rF`'�•rr'°`�.. "�'..ef. fr F �'i _:«w,,'�,q�:... ..��..r,,:.�L�� � ,.''4�'. ', s. ISSUED: 07/10/2016 DISPLAY AS REQUIRED BY LAW SEQ# L1607100001932 010642 a Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT A BILL—DO NOT PAY 6399281 \I.LBT -Ij .a BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES RELATED SYSTEMS INC RENEWAL SEPTEMBER SO, 2017 7152 LAUREL LA 6667365 Must be displayed at place of business MIAMI LAKES FL 33014 Pursuant to County Code Chapter 8A—Art.9&10 OWNER SEC.TYPE OF BUSINESS U I ESS IDS r'RELATED SYSTEMS INC 196 SPEC ELECTRICAL CONTRACTOR PAYMENT RECEIVED f r/ I - iGO000104 LBYFAXCOLLECTOR P r . Worker(s) $45.00 07/10/2016 � -- CREDITCA'RD-16-037814 This Local Business Tax Receipt only confirms payment of the Local Business Taxa" The Receipt is not a license, }� permit or a certification of the holders qualifications,to do business.'Holder must comply with any governmental. _r nnongovernmental regulatory laws and requirements which apply to the business. o � t E ,� The RECEIPT NO.above must be displayed on all commercial vehicles' Miami—Dade Code Sec ea-26. f #-- " For more information,visiitwv w miamidede govflaxcollector---� J--p --- t i v 6 .4 AC'�® DATE(MM/DD/YYY1� 40 CERTIFICATE OF LIABILITY INSURANCE 6/21/2017 THIS I.ERTIFICATE 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 policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Tracy Brahm Setnor Byer Insurance & Risk PHONE (954)382-4350 F Ne:(954)382-2910 900 S. Pine island Road #300 ADDRIESS:certificates@setnorbyer.com INSURERS AFFORDING COVERAGE NAIC# Plantation FL 33324 INSURERANautilus Insurance Company 17370 INSURED INSURER B Related Systems Inc INSURER C: 7152 Laurel Lane INSURER D: Y INSURER E: Miami Lakes FL 33014 INSURER F: COVERAGES CERTIFICATE NUMBER:2016 1122 Master REVISION NUMBER: tTHIS 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 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER M DD M DD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE �OCCUR DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ NN740447 11/9/2016 11/9/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X JECT LOC PRODUCTS-COMP/OP AGG $ Included POLICY F] PRO rl OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident I UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ + DED RETENTION $ WORKERS COMPENSATION PER OTH- ANDEMPLOYERS'LIABILITY Y/N STATUTE I ER 1 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Alarm Contractor (license #0000104) { CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village Building Dept. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 NE 2nd Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Tracy Brahm/DAWNC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I N S025 rqn t 4n i I I WE JEFF ATWATER CHIEF FINANICAL OFFICER STATE OF FLORIDA DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION **CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDA WORKERS'COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers'Compensation law. EFFECTIVE DATE: 8/18/2016 EXPIRATION DATE: 8/18/2018 PERSON: ADAMS RONALD C FEIN: 800315949 BUSINESS NAME AND ADDRESS: RELATED SYSTEMS INC. 7152 LAUREL LANE MIAMI LAKES FL 33014 SCOPE OF BUSINESS OR TRADE: Burglar and Fire Alarm Installation or Repair&Drivers IMPORTANT:Pursuant to Chapter 440.05(14),F.S.,an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter.Pursuant to Chapter 440.05(12),F.S.,Certificates of election to be exempt...apply only within the scope of the business or trade listed on the notice of election to be exempt.Pursuant to Chapter 440.05(13),F.S.,Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if,at any time after the filing of the notice or the issuance of the certificate,the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate.The department shall revoke a certificate at any time for failure of the person named on the certificate to meet the requirements of this section. DFS-F2-DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 08-13 QUESTIONS?(850)413-1609 JUN 17017 Exterior siren and strobe above door 1 ST F L O OR ' I i I I I I I !1 I y I r 7 c-,10 C M-02 C 01 Y Aar SYStne KP 1: mI location II dImo, L f I C-16 C-05 C-04 I C-03 C-02 ! 't — C1tJV S=1`1 1 l��rens �d�3C1�3 1-Id kJ IM�JIJ;1.1d1N:�0 O. I ICA Te _ 1 CONTACT -------------� I Y KEYPAD - Litzenberg Residence M-01 1420 N.E.103 Street Miami Shores, Florida 33138 I I ' JUN 2 2 2017 2No FLOOR I I I I I I I I I I i - Interior siren ae door II ' I C-17 C-16 C-15 C-14 C 11 11 i C-18 C-19 1 , 1 I 1 I 1i N C-21 C-20 �� I CONTACT - F 11 1 I _ KEYPAD Litzenberg Residence i I I I 1 t I I 1 1 1 1420 N.E.103 Street I04 Miami Shores, Florida 33138 i