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EL-10-1796Scheduled Inspection Date: November 01, 2010 Inspector: Devaney, Michael Owner: SANTANA, MARIANA Job Address: 739 NE 94 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ADT SECURITY SERVICES, INC Building Department Comments October 29, 2010 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 152760 Permit Number: EL -10 -10 -1796 For Inspections please call: (305)762 -4949 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number (305)510 -3766 Parcel Number 1132060142000 Phone: (786)331 -3967 BURGLAR ALARM Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments iy( Page 25 of 25 Miami Shores Village .9/ ©Th 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 BUILDING PERMIT APPLICATION FBC 20 Permit Type: ELECTRICAL Owner's Name (Fee Simple Titleholder) 1ez ®S is e //2 Phone # ,176-77 Owner's Address 73 7 f J 5� City /1r4,"/ S o State P/ Zip 3 (.? r Tenant/Lessee Name Phone # Email Job Address (where the work is being done) * ' ` C:./ ► L ' 1 , City Miami Shores Village County UO- Permit No. � , Master Permit No. Miami -Dade Zip FOLIO / PARCEL # //" 330 6 —6/4'- 0o0c) Is Building Historically Designated YES NO Contractor's Company Name /�� Sa -��[ W2 r Phone # :c'' = 2- 6 1 6',.57/7" o .t /e Contractor's Address � °� �.�� City !t!.# State? • Zip Qualifier Name ea , x 1 7ji / Lenj Phone # V State Certificate or Registration No. ecd d) // 2-7 Contact Phone E -mail COg C,(lol c Certificate of Competency No. Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit 0 r r o 0"-° / Square / Linear Footage Of Work: Type of Work: QA []Alteration Describe Work: ( 1 l /2 gel '2) DNew ❑ Repair/Replace ❑ Demolition * * *** * *** **** r r*** *** * ****** ** * * *•x *, *Fees, * * *,r ** * ** r, * * *, * * * * *** ** * ** * **** * * * * *** Submittal Fee $ ' Permit Fee $ CCF $ CO /CC $ Notary $ Training/Education Fee $ Scanning $ Radon $ DPER $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ (00. Flood Zone Z . 91":)2,6 -. /1 Technology Fee Bond $ See Reverse side -5 Bonding Company's. Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicaEl 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 WITII 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 re- inspection fee will be charged. Signature er or Agent The foregoing instrument was acknowledged before me this 6 day of O , 20f by Sign: �1/ Print: ATOTAB`1 F Z 5'Ter ( i(' ' It Aguila My CommissiP m scion # DD 82830 Expires: JULY 2G, 2011 BoNEL Tl 4W ATLANTIC BONDING CO., INC. (Revised 07 /10 /07XRevised 06/10/2009) who is personally known to me or who has produced PL Off. 41g i dentification and who did take an oath. NOTARY PUBLIC: APPROVED BY / > 17 Gi'iO Plans Examiner Engineer Signature * * * * * * * * * * * *** * * * * * ** ************** * * * * * * ** * * * * * * * * * * * * * * * * * * * * * * Contractor: The foregoing instrument was acknowledged before me this day of 0 , 2Q/6 , by who is personally known to me or who has produced identification and who did take an oath. NOTARY PUBLIC: Sign: Print !YOTilftTB 9 rCL pF FLORIDA My Commission e_lba Aguila Commission 4 DLV82830 10,„ ,' Expires: JULY 26, 2011 BONDED TIRU ATLANTIC BONDING CO., INC. ***** * * * * * *** * * ** * * * * * * * * *** * * * * * * ** Zoning Clerk checked loll Y CR/1VCJ va..■■ 111 rvr. 1 r_ rlv•,u,IS. • --- 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 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 LTR TYPE OF INSURANCE I ADDL CONTACT NAME: SUBR IA. f POLICY &F • POLICY EXP I LIMITS POLICY NUMBER MM/DD /YYYY MMIDD/YYYY F !GENERAL I I X X { . LIABILITY COMMERCIAL GENERAL LIABILITY _ ] CLAIMS -MADE (X I OCCUR OWNER'S & CONTRACTOR'S , , COMPANY A: AGCS Marine Insurance Company (Allianz) COMPANY B: CHARTIS CASUALTY COMPANY COMPANY C: Commerce & Industry Ins Co COMPANY D: Illinois National Insurance Co. COMPANY E: Nat'l Union Fire Ins Co of Pittsburgh, PA COMPANY F: New Hampshire Ins. Co. GL 4360884 (Primary GL) 1 10/1/2010 10/1/2011 EACH OCCURRENCE $2.000,000.00 - bAMAGE TO RENTED PREMISES Ea occurrence $1,000,000.00 ( ) I - - — -- - -- -- — I MED EXP (Any one person) I - _$10,000.00 PERSONAL & ADV INJURY 52,000,000.00 L- — GENERAL AGGREGATE 54,000,000.00 PRODUCTS - COMP /OP AGG $4.000.000.00 GEN,' AGGREGATE LIMIT APPLIES PER I L - -1 PRO I POLICY I JECT - LOC - - - --- — - E E F AUTOMOBILE X _ . • X r X , LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS CA 3976576 (VA) 1 0/1/2010 10/1/2011 CA 3976575 (AOS) 10/1/2010 10/1/2011 CA 3976577 (MA) 10/1/2010 10/1/2011 CA 3976624 (NH) (Primary AL) 10/1/2010 • 10/1/2011 - COMBINED SINGEL LIMIT ■EA ACCIDENT/ NEW HAMPSHIRE COMB SINGLE LIMIT E LIMIT BODILY INJURY (Per person) ...... .. . . ..._ _.. .... BODILY INJURY (Per accident) ' PROPERTY DAMAGE ._ (Per accident) -- - 57.500.000.00 000 5250,000 .... ... - -- -- - -- LL LL X UMBRELLA LIAR EXCESS LAB X OCCUR 1 CLAIMS -MADE CA 3976625 (NH) (Excess AL) 10/1/2010 ,10/1/2011 GL 4360885 (Excess GL) 10/1/2010 110/1/2011 EACH OCCURRENCE AGGREGATE _ $5,500.000.00 $11.000,000.00 PRODUCTS - COMP /OP AGG $11.000,000.00 DEDUCTIBLE RETENTION $ NEWHAU,,nEESALODAO MENGtclmn: 57,250,000 1 0 V0WLLLLLLI WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N N / A WC 026149517 (CT.GA.PA.SC) WC 026149514 (FL) WC 0261495161Mq WC 026149513 (CA) WC 026149518 (MA, ND,NY.OH.WA.WI.WY) WC 026149515 (TX) WC 026149519 (AOS) WC 026149548 (MN) 10/12010 10/12011 10/1/2010 10 /1/2011 10/1/2010 10/12011 10/1/2011 X WC STATU TORY LIMITS OTH ER E.L. EACH ACCIDENT 52,000,000.00 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? 10/12010 10/1/2010 10/12010 10/1/2010 10/1/2010 10/12011 10/12011 10/1/2011 10/1/2011 E.L. DISEASE - EA EMPLOYEE $2,000,000.00 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $2,000,000.00 - OTHER Binders Risk/installation/Contract Works Renlal Equipmen0Conlracloes Equipment Blanket Transit OC & OCW 91128600 OC & OCW 91128000 OC & OCW 91128600 5/12010 5/10010 5112010 5/1/2011 5112011 5112011 USD $1.000.000 00 per jobslte USD $1.000.090 00 per jobsee USD 51.000.000 00 per conveyance .- DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Jot H∎oA. r rl, , t.IAA:l SHCRE.S VILLAGE r„el.,x, NMrr. El, CE EIANt SEL'AES VILLAGE':,.:: 11/,n1A r 717, ' EIAAI At VILLAGE 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(ies) 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 Marsh, Inc . 1166 Avenue of the Americas New York, NY 10036 Telephone (212) 345 -5000 CONTACT NAME: PHONE FAX (A /C, No, Ext): (A/C, No): E -MAIL ADDRESS: PRODUCER CUSTOMER ID #: _ INSURER(] AFFORDING COVERAGE NAIC # INSURED ADT Security Services, Inc. 7747 NW 48th St Suite 160 Bldg D Miami, FL 33166 -5407 United States COMPANY A: AGCS Marine Insurance Company (Allianz) COMPANY B: CHARTIS CASUALTY COMPANY COMPANY C: Commerce & Industry Ins Co COMPANY D: Illinois National Insurance Co. COMPANY E: Nat'l Union Fire Ins Co of Pittsburgh, PA COMPANY F: New Hampshire Ins. Co. GtK 1 II I t 11ULUtK CITY OF MIAMI SHORES VILLAGE 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 United States SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /tom 1X epp p MARSH USA INC. BY Franklin H01/005. Global Menne David Kon. Casual( Pr..10,0 T .nS'l Pro. -m .. ..... rs nnoorsr3nTlrl Al All rinhfc rpcprved. ACO GIR ACORD 25 (2009/09) CERTIFICATE OF LIABILITY INSURANCE • The ACORD name and logo are registered marks of ACORD For questions regarding this certificate contact: Alba Gaona (Email: agaor.a:adt.com Phone: '85 331 3357) DATE (MM/DD/YYYY) 9/26/2010