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EL-10-2033Inspection Number: INSP - 154161 Scheduled Inspection Date: December 14, 2010 Inspector: Devaney, Michael Owner: DEL VALLE, ROLANDO Job Address: 717 NE 91 Street 4 -B Project: <NONE> December 13, 2010 Miami Shores, FL Contractor: DEFENDER SECURITY COMPANY' Building Department Comments Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Number: EL -11 -10 -2033 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number Parcel Number 1132060440080 Phone: (317)810 -4720 ALARM INSTALLTION Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments For Inspections please call: (305)762 -4949 Page 25 of 30 DEFENDER DIRECT Jose Rodriguez Saute Installation Manager 786.413.9868 jr8118@defenderdrrect.com defenderdlrecfcom pmteclyouhome.com erUoybettertacom DEFENDER Direct, Inc. Miami, Florida 3901 NW 79 Ave Ste #224 Dora!, FL 33166 DEALER FOR: AT ciseR 4 f BUILDING PERMIT APPLICATION FBC 20 NNalue -of Work for this Permit: $ Type of Work: ❑Address ❑Alteration Description of Work: / 404 az....-se> Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 • Permit No. f I D Master Permit No. Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): (9 1��G"." Monet 3 S Address: 7/ 7 A/ 9/ 9' 6 _ City: /"® f3�1 r �i�Dv��S . State: �G Zip: 33 / � Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: - 7/ ? N f 9/ -# 4' City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: " - isf4 Z S2/2', `U'ePhone #: . ) — .P/D° 1.- /720& - i - " Address: 3 ?S?) 0 .2•0‘,17--.0.07 Ga2.t 4471 A. :;3, 1# ) 0 di/e City: / •.D, 4 0 US State: /�/ Zip: 4/6' Z Qualifier Name: e9,`"?".,/ Sbole/me.- . Phone #: 3/ 7 J Q ? 72-04,-"- £// State Certification or Registration #: 'C/ -3cN 3 / Z 7. Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Square/Linear Footage of Work: _ UNew ❑Repair/Replace ❑Demolition ******** ****************************F * * ** x**+ n+ x*** ****** ************* ** * * ***+x***** Submittal Fee $ Permit Fee $ /Owed CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ &k V 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 ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 t' absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature O or Agent The foregoing instrument f tru t s acknowledged before me this The forego strument as acknowledged before me this if aa ,, day of , 20 _ ,by - V[ , day of ,20 LL, by _I 3Clo 02. e who is personally known to me or who has produced As identification andSIybolg4 take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: APPROVED BY (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) \s \-o d) �n I ' a s \ � `\`\e\ � / ► ► ► ►Ifil11111 \ \ \ \\ Signature Structural Review who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: AOPA— Sign: Print: My Commis., Contractor ‘o *, TAMARA L TOLSON ,a i3 Notary Public. State of Indiana Hamilton County Commission # 612622 My Commission Expires October 21, 2017 a,+r*x ******** ***** ******> p: a+ s**** *******> x :x***** *** ** * *** ************ ** * *** * * * * * ** * * *** * ******** *** * *** ** - Plans Examiner Zoning Clerk COVERAGES CERTIFICATE HOLDER ACORD 25 (2001108) 1 of 2 Ciient#:12385 #S2001911M200003 DEFESEC ACORD. CERTI[ "ATE OF LIABILITY INSURANCE PRODUCER MJ Insurance, Inc. PO Box 50435 Indianapolis, IN 40250-0435 317 805-7500 INSURED Defender Security Company DBA ADT ** NAMED INSD CONTINUED IN DOO 3750 Priority Way S. Drive, Suite 200 Indianapolis, IN 46240 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: First Mercury Ins. Co: NON -ADMI INSURER B: Navigators Insurance Company INSURER C: Amerisure Mutual Insurance Co. INSURER 0: Amerisure Insurance Company INSURERS: Charter Oak Fire Ins. Co. DATE (MMIDDIYYYY) 10/06/2010 NAIC # 10657 42307 23396 19488 25615 1NSR TR A THE POLICE OF INSURANCE IJSTED 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 SE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. o.0 Li11.1 P • ICY EFFECTIVE D. t:,,,Lo 1 07101110 COMBINED B ADD'L SR X TYPE OF INSURANCE GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY I CLAIMS MADE OCCUR $5,000 DED B1: PD AND /OR GEN . AGGREGATE LIMIT APPLIES PER: POLICY n YE n LO AUTOMOBILE LIABILITY ANY AUTO X AU. OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON-OWNED AUTOS X PHYSICAL DAMAGE GARAGE LIABILITY R ANY AUTO EXCESSIUMBRELLA LIABIUTY OCCUR El CLAIMS MADE DEDUCTIBLE X RETENTION S 0 POLICY NUMBER FMM1020041 PER OCCURRENCE PERSONAL INJURY 'AB301A60910 $500 COMP DED $500 COLL DED NYI0EXC7112091V 07101110 POLIO ' '' IRA 07101111 07101/11 07101/11 LIMITS EACH OCCURRENCE s1,000 000 P ISES fffa acca Beet MED 51 D0,000 M P7IP (My ona parson) s5,000 PERSONAL B ADV INJURY GENERAL AGGREGATE PRODUCTS - COMPIOP AGO COMBINED SINGLE LIMIT (En aeetdanr) BODILY INJURY (Pat parson) BODILY (Par =WPM) INJURY ae PROPERTY DAMAGE (Paracddant) AUTO ONLY - EA ACCIDENT EA ACC OTHER THAN AUTO ONLY: AGO EACH OCCURRENCE AGGREGATE s1,000 000 $2,000,000 52,000,000 x1,000,000 S S S S 07101110 $ S s10.000,000 s10,000,000 S S C N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PROPRIETORIPARTNEIVEXE OFFICER/MEMBER EXCLUDED? cunvE SPECI asolbe PROVISIONS belam D OTHER WORKERS' COMPENSATION WC2064942 3A-IN 3C -OTHER STATES INS EXCEPT ME,ND,OH,WA,WY WC2064940 3A -IN 3C -OTHER STATES EXCEPT 10/07110 10/07/10 10107/11 10/07111 ME WA,WY DESCRIPTION OF OPERATIONS I LOCATIONS " "''!CLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECUU. PROVISIONS **NAMED INSURED CONTINUE. _4a Defender Alert; dlbla Direct Dish Satellite TV X I TORYI I I I ER E.L. EACH ACCIDENT x1,000,000 E.L. DISEASE-EA EMPLOYEE 51,000.000 E.L. DISEASE MOT LIMIT x1,000,000 $1,000,000 PER ACCIDENT $1,000,000 PER EMPLOYEE $1,000,000 POLICY LIMIT S CANCELLATION 10 Days for Non - Payment Miama Shores Village Community Development 10050 NE 2nd Avenue Miami Shores, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL , 3A DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE _ Ad,. SAL B ACORD CORPORATION 1908