EL-09-195301/19/2010 14 :11 FAX 1 800 685 7530 DATA SCAN FIELD SERVICES
Inspection Number: I NSP- 133578
Scheduled Inspection Date: January 19, 2010
Inspector: Devaney, Michael
Owner: ANNIS, MARGARET & PAUL
Job Address: 422 NE 93 Street
Project: <NONE>
Miami Shores, FL 33138-
Contractor: ADT SECURITY SERVICES, INC
Building Department Comments
INSTALLING LOW VOLTAGE ALARM SYSTEM
Passed
7
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
PLEASE CALL BEFORE GO
PLEASE MAKE THIS INSPECTION THE LAST OF YOUR DAY!!!
THANKS!!!!
305.498.7627
January 15, 2010
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
G ••
Q006/012
Permit Number: EL -11 -09 -1953
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alarm
Phone Number
Parcel Number 1132060140211
Phone: (786)331 -3967
Page 18 of 23
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Parcel Number
422 93 Street
Miami Shores, FL 33138-
1132060140211
Block: Lot:
MARGARET & PAUL ANNIS
Owner Information
Address
MARGARET & PAUL ANNIS
379 94 Street
MIAMI SHORES FL 33138 -2842
Valuation:
Total Sq Feet:
$ 1,000.00
0
Contractor(s)
ADT SECURITY SERVICES, INC (786)331 -3967
Phone Cell Phone
Phone
Type of Work: ELECTRICAL
Additional Info: ALARM
Classification: Residential
Fees Due
CCF
Education Surcharge
Permit Fee - Additions/Alterations
Scanning Fee
Submittal Fee
Submittal Reversal Fee
Technology Fee
Total:
Amount
$0.80
$0.20
$100.00
$3.00
$50.00
($50.00)
$0.80
$104.60
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Invoice # Total Amt Paid Amt Due
EL -11 -09 -36499 $ 104.60 $ 54.60
EL -11 -09 -36499 $ 104.60 $ 104.60 $ 0.00
Check #: 3673
Applicant
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 and zoning. Futhermore, I authorize the above -named contractor to do the work stated.
December 02, 2009
Date
Expiration: 05/30/2010
Cell
For Inspections please call:
(305)762 -4949
Available Inspections:
Inspection Type:
1
December 02, 2009 1
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: ELECTRICAL
Owner's Name (Fee Simple Titleholder) „sh(,WY ® , Phone #(30ST) L( q — Co 2:7
City /a /1'll Shoreg State f Zip 36/3!
Tenant/Lessee Name Phone
Email
Owner's Address
Job Address (where the work is being done) 4°22-- eAs
City Miami Shores Village County Miami -Dade Zip 3a/ gel
FOLIO / PARCEL # // e 711 -0/9"-07,//
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address / 9 P5
City f eZ l ` /
al e / na
Certificate of Competency No.
State
Qualifier Name ��yy��,,
State Certificate or Registration No. F�-- 0012// i-/
Contact Phone
Architect/Engineer's Name (if applicable)
d J
Value of Work For this Permit $ 015 -
Describe Work:
CcA7 - .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
E -mail
Permit No. ` — I 3
Master Permit No.
Phone #
Zip ,330
Phone #
act u la a_ c�����ao
Square / Linear Footage Of Work:
trgt
NOV 2 4 2009 EI9
BY: if*- • J
Flood Zone
Type of Work: ❑Addition EAlteration [New ❑ Repair/Replace Demolition
❑
of - � , r � e '49
- �
Cl 1
(q
**** * * * * * * * * * * * * * ** * * * * * * * * * * ** * * ** Fees** * * * * * * * * * * * *** * * * * * ** * * * * *** * **
Submittal Fee $""( Permit Fee $ / e'®r ®® CCF $ ® tco O CO /CC $
Notary $ Training/Education Fee $ 0.2,0 Technology Fee $ 0 ' ZcO
Scanning $ 3- Radon $ DPBR $ Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $ 54 .00
See Reverse side
Bonding Company's Name (if applicable)
Bonding Company's Address
City
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
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 i occurs sever (7) days after the building permit is issued. In the absence of such Bpated notice, the
inspection will not b appr. ved ' pection fee will be charged.
Zip
Cs 43.
Signature !� r Signature
gent Contractor
The fore ing instrument w acknowledged before me this2s3 The foregoing instrument was acknowledged before me this
d a y , 200' , by , day . ` , by
who is personally known to me or who has produced who is =smelly known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
w /4
My Commission ExpireNDTARY PUBLIC -STATE OF FLORIDA
" Alba Aguila
'• ' '' Commission # DD682830
Expires: JULY 26, 2011
APPROVED BY
(Revised 07 /10 /07XRevised 06/10/2009)
Plans Examiner
Engineer
NOTARY PUBLIC:
Sign:
Print:
&' V'e
4
My Commission Expires; TARY PUBLIC -STATE OF FLORIDA
Alba Aguila
Commission #DD682830
,, ° Expires: JULY 26, 2011
'�'� '1� tttlfittettrei;d ck ; ,r*
Zoning
Clerk checked
PRODUCER
Marsh, Inc.
1166 Avenue of the Americas
New York, NY 10036
Telephone (212) 345 -5000
INSURED
ADT Security Services, Inc.
7747 NW 48th St
Suite 160 Bldg D
Miami, FL 33166 -5407
United States
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIRMENTS, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE
AFFORDED BY THE POLICIES LISTED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY
PAID CLAIMS.
CO
LTR
G
F
F
F
A
B
D
E
F
F
G
G
G
G
C
C
C
TYPE OF INSURANCE
GENERAL LIABILITY
X
COMMERCIAL GENERAL
CLAIMS MADE
X
OWNERS & CONTRACTORS
OCCU
AUTOMOBILE LIABILITY
X ANY AUTO
X HIRED AUTOS
X NON -OWNED AUTOS
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR/
PARTNERS/EXECUTIVE
OFFICERS ARE:
EXCESS LIABILR Y
X
OTHER THAN UMBRELLA FORM
UMBRELLA FORM
PROPERTY
OTHER
Builder's Riskinstallation/Contract Works
Rental Equipment/Contractor's Equipment
Blanket Transit
ERT1
POLICY NUMBER
GL 090 -73-63 (Primary GL)
CA 091 -93 -98 (MA)
CA 091 -93 -97 (VA)
CA 091 -93 -96 (AOS)
WC 060-16 -8747 (CT,GA,PA,SC)
WC 060 -16 -8741 (FL)
WC 060 -16 -8744 (MI)
WC 060 -16 -8745 (AR,MA,VA)
WC 060-16 -8742 (OR)
WC 060 -16 -8740 (CA)
WC 060 -16 -8748 (AOS)
WC 060 -16 -8743 (TX)
WC 060168746 (ND,NY,OH,WA,WI,WY)
GL 090 -73 -64 (Excess GL)
OC 9112860
OC 9112860
OC 9112860
CERTIFICATE HOLDER
CITY OF MIAMI SHORES VILLAGE
10050 NE 2ND AVENUE
MIAMI SHORES, FL 33138
United States
GATE OF CNSU
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO
RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE POLICY.
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
POLICIES DESCRIBED HEREIN.
COMPANIES AFFORDING COVERAGE
COMPANY A:
COMPANY B:
COMPANY C:
COMPANY D:
COMPANY E:
COMPANY F:
COMPANY G:
Al South Insurance Co.
Commerce & Industry Ins Co
Fireman's Fund Insurance Company
Illinois National Insurance Co.
Insurance Company of the State of PA
Nat'l Union Fire Ins Co of Pittsburgh, PA
New Hampshire Ins. Co.
POLICY EFFECTIVE
DATE (MM/DD/YY)
10/1/2009
10/1/2009
10/1/2009
10/1/2009
10/1/2009
10/1/2009
10/1/2009
10/1/2009
10/1/2009
10/1/2009
10/1/2009
10/1/2009
10/1/2009
10/1/2009
5/1/2009
5/1/2009
5/1/2009
POLICY
EXPIRATION
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
5/1/2010
5/1/2010
5/1/2010
LIMITS
GENERAL AGGREGATE
PRODUCTS - COMP /OP AGG
PERSONAL & ADV INJURY
EACH OCCURRENCE
FIRE DAMAGE (Any one fire)
MED EXP (Any one person)
COMBINED SINGLE LIMIT
xi-WC STATUTORY
LIMITS
OT HE
EL EACH ACCIDENT
EL DISEASE - POLICY LIMIT
EL DISEASE -EACH
GENERAL AGGREGATE
PRODUCTS - COMP /OP AGG
EACH OCCURRENCE
CERTIFICATE NUMBER
656487
$4,000,000.00
$4,000,000.00
$2.000.000.00
$2,000,000.00
$1,000,000.00
$10,000.00
$7,500,000.00
$2,000,000.00
$2,000,000.00
$2,000,000.00
$11,000,000.00
$11,000,000.00
$5,500,000.00
USD $1,000,000.00 perjobsite
USD $1,000,000.00 perjobsite
USD $1,000,000.00 per conveyance
DESCRIPTION OF OPERATIONS/LOCATIONS /VEHICLES /SPECIAL ITEMS
Job Number: CITY OF MIAMI SHORES VILLAGE Customer Number: CITY OF MIAMI SHORES VILLAGE Town Number: CITY OF MIAMI SHORES VILLAGE
CANCELLATION „
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION E THEREOF, THE
INSURE AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS WRF I EN NO TICE TO THE CEDATRTIFICATE HOLDER
NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPOI
THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR 7HE ISSUER OF THIS CERTIFICATE.
MARSH USA INC, BY: Frenklin Haliock, Global Marine
David Kong, Casualty Program Tr ansit P rogram
�2OO9
iswt 11
For questions regarding this certificate contact: Alba Gaona (Email: agaonaEadt.com Phone: 786 331 3967)
STATE OF FLORIDA
1 )�Yt�lZi'M�1V'1 Cil liu6.011L' Sb HLVL
ELECTRI CONTRACTORS. LICENSING BOARD
1940 NOR MONROE STREET
TALLAHASSEE FL 32399 -0783
•
MANGINELLI, GEORGE A
- ADT SECURITY SERVICES INC
ONE TOWN CENTER ROAD
BOCA RATON FL 33486
t liUi.iSbbiU1Vttu
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 from architects to yacht brokers, from
boxers to barbeque restaurants, and they keep Florida's. economy strong.
Every day we work to improve the way we do business in order to serve you better.
For information about our services, please log onto www.myflorfdaiicense.com.
There you can find more information about our dMsions and the regulations that
impact you, subscribe to department newsletters and team more about 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 serve your customers.
Thank you for doing business in Florida, and congratulations on your new license!
0/7
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(850)1 487 -1395
SEE OTHER SIDE
DO NOT FORWARD
ADT SECURITY SERVICES INC
ATTN LICENSING DEPT
10785 MARKS WAY
MIRAMAR FL 33025
1►► 1L►► ltal►►►►► 1► Ll ►L►►I1►61►►1►►►Lll►,l ►►1►►1►i►1 3
M I,'FL 33130
ADT SECURITY SERVICES INC
7747 NW 48 ST
33166 UNIN DADE COUNTY
SEE OTHER SIDE
BUSINESS NAME /LOCATION
ADT SECURITY SERVICES INC
7747 NW 48 ST
33166 DORAL
M ' ST B ,D
PURSUANT TO COUNTY CODE CHAPTER 8A+ ART. 9'8i
STATE# EF0001121
160
OWNER
ADT SECURITY SERVICES INC
Sec. Tjf of Business WORKER /S
1 96 SPEC ELECTRICAL CONTRACTOR 33
8 18 ONLY A LOCAI.
UNE88 TAX RECEIPT. IT
F8 NOT PERIET THE
.DER TO VIOLATE ANY
DO NOT FORWARD
ADT SECURITY SERVICES INC
JOHN B KOCH
10785 MARKS WAY
MIRAMAR FL 33025
' 1111111 ' 111 ' 111111111 ' 1 11111111 IIT1111111'111111111111111klat
OWNER
ADT SECURITY SERVICES INC
Sec. Type of Business
- 217 SECURITY SYSTEMS MONITORING
THIS 18 ONLY A LOCAL
8118UIE88 TAX RECEIPT. IT
DOES NOT PERMIT THE
160
DO NOT FORWARD
ADT SECURITY SERVICES INC
ATTN LICENSING DEPT
10785 MARKS WAY
MIRAMAR FL 33025
RECEIPTtrT 520I
111 11 11 t ill t ilt I 111 I ► 1
'1WUI111A1; FL
PERMIT NO. 231
r. FL
PERMIT NO. 231