Loading...
EL-02-20-299Miami Shores Village 10050 NE 2 Ave Miami Shores FL 33138 305-795-2204 Location Address Permit NO.: EL-02-20-299 Permit Type: Electrical - Residential Work Classification: Low Voltage Permitstatus: Approved Issue Date: 02/1312020 Expiration: 08/11/2020 Parcel Number 115 NE 94TH ST, Miami Shores, FL 33138 1132060132870 Contacts WILLIAMJURBERG Owner RELATED SYSTEMS INC Contractor 115 NE 94 ST, MIAMI SHORES, FL 33138 RONALD CARL ADAMS Home: 3056093851 7152 LAUREL LN, MIAMI LAKES, FL 33014 Description: INSTALL CCTV SYSTEM Valuation: $ 2,387.00 Total Sq Feet: 0.00 Fees Amount Application Fee - Other $50.00 CCF $1.80 DBPR Fee $2.00 DCA Fee $2.00 Education Surcharge $0.60 Permit Fee $50.00 Scanning Fee $9.00 Technology Fee $2.50 Total: $117.90 Building Department Copy EWE I a s Y...hlikb.' ttVSi it M" . Payments Date Paid Amt Paid Total Fees $117.90 Check# 11067 02/13/2020 $117.90 Amount Due: $0.00 In consideration of the issuance to me of this permit, 1 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 and zoning. Futhernore, I authorize the alcove n5red contractor to do the work stated. Authorized Signature: Owner / Applice Contractor / gent Date a -/3 -an90 February 13, 2020 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 IECTRIC ❑ ROOFING Master Permit gECEIVED F g 0 7 2020 FBC 20 Sub Permit No. ❑ REVISION ❑ EXTENSION [-]RENEWAL ❑PLUMBING ❑ MECHANICAL [—]PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP // ��. CONTRACTOR DRAWINGS JOBADDRESS: /1S1t1E, City: Miami Shores County: Miami Dade Zip: 33/ 158 Occupancy Type: Load: OWNER: Name (Fee S• Arldrpcc• /�(F` , the Building Historically Designated: Yes NO Construction Type: Flood Zone: BFE: FFE: F _ a� --, U (t? Phone#: City: 14 /A'w1.1 Gt­� ofL4State: Tenant/Lessee Name: Y Email: �� ,�.--�� �I����� -y—� / �c CONTRACTOR: Company Name: '95 J 1 , S1� r��tr'S.� f'"c� Phone#: �� � l ��yp i" Address: 7t!S'2 "--VQGA- L-AA)a City: 1" t /4�' H '�,(,�^'�? State: '1^ 1-- - Zi�p:� 7/ 74D / Qualifier Name: I �Ft yD daf2i, A>AOA S Phone#: �fJS �%S S rr16(O State Certification or Registration #: o� OO7 �Z> �d Certificate of Competency #: DESIGNER: Architect/Engineer: Value of Work for this Permit: Type of Work: .0 Addition ❑ Alteration Description of Work: 1Ai 6170-1-L ec State: Zip: Square/Linear Footage of Work: ❑ New ❑ Repair/Replace ❑ Demolition Specify color of color thru tile: Submittal Fee $—P— Permit Fee $ CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Notary $ Technology Fee Structural Reviews $ Training/Education Fee $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ 90 (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. Signature Signature WNER VIAGENT CONTRACTOR The foregoing instrument was acknowledged before me this " day of 20 ;0 µ+ by lw 40 SV OZU& w o is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: The foregoing instr en was acknowledged before me this �_ day of Z� 20 �, by -Q o A;-0 A�"!S o is personally known to as me or who has produced identification and who did take an oath. NOTARY PUBLIC: Print: , , N•AnAmS— Seal: .. MY COMMISSION#GG28n22 ;..'+.; EXPIRES: January 20, 2023 '•.+<.0,' F0`pBanded tivu Wo Public underwriters as +rrrrr»r»r+»»»r+r++r+»++rr»r»r»»»r»rrrr+r+r�rr�rrr»rrr»»+rrrrr»r:rrrrrrrrrrrrrrrrr»++rrrr+rr»»++rr++++++++++++ APPROVED BY `�-2r—- s Examiner Zoning Structural Review Clerk (Revised02/24/2014) RICK SCOTT, GOVERNOR JONATHAN ZACHEM, SECRETARY a dbpr STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD THE ALARM SYSTEM CONTRACTOR II HEREIN IS CERTIFIED UNDER THE PROVISIONS OF CHAPTER 489, FLORIDA STATUTES ADAMS, RONALD CARL RELATED SYSTEMS INC 7152 LAUREL LANE MIAMI LAKES FL 33014-2664 LICENSE NUMBER: EG0000104 EXPIRATION DATE: AUGUST 31, 2020 Always verify licenses online at MyFloridaLicense.com 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. 003463 A 'Local Business Tax Receipt Miami —Dade County, State of Florida -THIS IS NOT A BILL - 00 NOT PAY 639928T -- BUSINESS NAME/LOCATION RELATED SYSTEMS INC 7152 LAUREL UN MIAMI LAKES FL 33014 LBT REEmTeo. EXPIRES RENEWAL SEPTEMBER 30, 2020 6667365 Must be displayed at place of business Pursuant to County Code 9 Chapter BA - Art. 9 & 10 OWNER SEC. TYPE OF BUSINESS RELATED SYSTEMS INC 196 SPEC ELECTRICAL CONTRACTOR PA9MENTRECEIVEO EG0000104 By TAX COLLECTOR Worker(s) 1 $45.00 08/20/2019 CREDITCARD-19-066637 This Local Business Tax Receipt only confirms payment of the Lecal Business Tex. The Receipt is not a license, parmit, or a certification of the holder's qualifications, to dohuainess. Holder moat comply with any governmental or nongovernmental regulatory laws and requirements which apply s. the der mum The RECEIPT NO. shove must he displayed on all commercial vehicles -Miami-Bade Code Sec 88-276. For more information, visit wwwm'em'dad factor ,Florida o «a,.A352-723-W 444..0 z a CA 15%FIL9SR14 s o®.tp(04tt963,ssax Ni "FE OR1VER main 1TA04I20T5 roar 6'-02" +r avr IgfyNE UM NONE a:ss 41H4f28lT } y ' t spp sossren,mp;. f"� � �e...non m,aew+,lirtr ea..m+n - .wm.m ra snr see,ry�r.�r.a eyw A� oe CERTIFICATE OF LIABILITY INSURANCE DA 1(MNUDE" 9Y) THIS CERTIFICATE 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 Setnor Byer Insurance & Risk 900 S. Pine Island Road #300 Plantation FL 33324 CONTACT NAME: Tracy Brehm PRONE (954)382-4350 FAAIXCNc: I asoae2-2a10 ADD TRESS;certificates@setnorbyer.com INSURERS AFFORDING COVERAGE NAIC 0 INSURERA: Nautilus Insurance Company 17370 INSURED Related Systems Inc 7152 Laurel Lane Miami Lakes FL 33014 INSURER B : INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2019 1108 toaster REVISION NUMBER: THIS 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 LTR TYPEOFINSURANCE AECIL SUM POLICY NUMBER MMDV� MN�EXP OMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A CLAIMS -MADE X OCCUR DA A ETO RENTED PREMISES Ee ocrunence S 100, 000 NED UP (Any one Person) S 5,000 NC476725 11/9/2019 11/9/2020 PERSONAL &ADV INJURY S 1,000,000 GENLAGGREGATE LIMITAPPUES PER: GENERALAGGREGATE S 2,000,000 X POLICY JECT LOC PRODUCTS -COMPIOPAGG S 2,000,000 S OTHER AUTOMOBILE LIASILITY COMBINED SINGLE LIMIT EA acedent S BODILY INJURY (Per person) S ANYAUTO ALL OWMED SCHEDULED AUTOS AUTOS BODILY INJURY (Peramtlenq $ PROPERTY DAMAGE Per Scold 'I $ NON -OWNED HIREDAUTOS AUTOS S UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS UAB CLAIMS -MADE DIED RETENTIONS $ 1 WORRERSCOMPENSATION ANDEMPLOYERS'IJABILITY YIN PER OTH- TAT E ER ANY PROPRIETORIPARTNERIEXECUTIVE E. L. EACH ACCIDENT $ EX OFFICERIMEMBER CLUDED'! ❑NIA (Mandator, In NH) E. L. DISEASE - EA EMPLOYEE $ It yes. describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Electrical License #EG0000104 Per Florida Statute 45 day Notice of Cancellation except in the event of nonpayment of premium, then 10 day notice. All of the above are subject to policy terms, limitations, exclusions and conditions. 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 �`�"��-_'` ,��a n� Tracy Brahm/TLK J-A )f{wwJr/j><YYsI ACORD 25 (2014101) INS025 (201401) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD JIMMY PATRONIS CHIEF FINANCIAL 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: 4/22/2019 PERSON: RONALD C ADAMS FEIN: 800315949 BUSINESS NAME AND ADDRESS: RELATED SYSTEMS INC. 7152 LAUREL LANE HIALEAH, FL 33014 SCOPE OF BUSINESS OR TRADE: Burglar and Fire Alarm Installation or Repair 8 Drivers EXPIRATION DATE: 4/21/2021 EMAIL: RON@RELATEDSYSTEMS.NET IMPORTANT: Pursuant to subsection 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 subsection 440.05(12), F.S., Certificates of election to be exempt issued under subsection (3) shall apply only to the corporate officer named on the notice of election to be exempt and apply only within the scope of the business or trade listed on the notice of election to be exempt. Pursuant to subsection 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 E00975379 QUESTIONS? (850) 413-1609 Notice to Owner — Workers' Com Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Insurance Exemption Florida Law requires Workers' Compensation insurance coverage under Chapter 440 of the Florida Statutes. Fla. Star. § 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 employer in the construction industry who employs one or more part-time or full-time 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 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. Signature: OwlAr State of Florida County of Miami -Dade The foregoing was acknowledge� before me this ALday of . By Q &--a Q-Q_ 0-aM4--- who is personally y� to me or has produced Notary: SEAL: as identification. YOLANDAVI ARAN-ADAMS MY COMMISSION # GG 282922 EXPIRES: January 2o, 2023 R E L A T E D S Y S T E M S K Date: 0 5 '-)U �U State of Pot,La County of = Before me this day personally appeared 1 C ��LLtM/�� who, being duly sworn deposes and says: That he or she will be the only person working on the project located at: n Contractor Signature Sworn to (or affirmed) and subscribed before me this day ofA 0 ;21) By-�� Personally know v OR Produced Identification Type of Identification Produced i 16310 2B2Y22 El0 M Jam Y 20.2023 Wa,dIWVNm,yPWkvlaW~ Print, Type or Stamp Name of Notary Installing alarm systems since 1985 W W W . R E L A T E D S Y S T E M S. N E T FLORIDA STATE LICENSE # E G❑ 0 0❑ 104 7 1 5 2 L A U R E L L A N E M I A M I L A K E S, F L❑ R I D A 3 3❑ 1 4 RELATED SYSTEMS INC. 71 52 LAUREL LANE MIAMI LAKES, FL 33014 William Jurberg 115 N.E. 94th Street Miami Shores, Fl. 33138 PROPOSAL Date Estimate # 1/6/2020 000002176 t�>���srrr���--1I��=ram=yaK�rvrn w7A Property Location: 115 N.E. 94th Street Miami Shores, FL 33138 Acct.# S5-1634 System Installation & Equipment List Qty Rate Total Install 8 customer supplied cameras and one 8 Channel DVR.: We will provide the cable,cable connectors, power supply and miscellaneous equipment to get everything running as well as setting up the system to view the cameras through your network and remotely on 3G or better cell phone's. See attached camera layout for locations. 16 Channel 8 Amp Thermal Fused - 12 Volt DC Rack Mountable camera power supply 1 196.90 196.90T Siamese Video Cable STANDARD RG59+ 2 conductor 18awg 1000 0.18 180.00T 2 PIECE BNC VIDEO CONNECTOR - CRIMP -ON. 16 0.90 14.40T TECHNICAL ASSISTANT LABOR HOURS @ $50.00 PER HOUR 32 35.00 1,120.00T TECHNICIAN LABOR HOURS @ $80.00 PER/HR. I HR. MINIMUM. 16 45.00 720.00T SUBTOTAL: 2,231.30 Please review this proposal and call Ron Adams at 305.785.7766 if you have any questions. Subtotal $2,231.30 Sales Tax (7.0%) $156.19 Total $2,387.49 07 William Jurberg 115 N.E. 94th Street Miami Shores, FI. 33138 I� Ma 0 M The 1080p resolution 2.8mm lens cameras to be installed have a Horizontal Field of View of 102 degrees compared to the 85 degree view shown on this diagram. DATE nr:I In IANC( NJITI I All, FEDi-IiAL. r�i i•::-iivtail i SnrdD Rr G111 A MI!,