EL-10-1323Project Address
Owner Information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Contractor(s)
ADT SECURITY SERVICES, INC (786)331 -3967
Phone CeII Phone
Fees Due
CCF
Education Surcharge
Permit Fee - Additions /Alterations
Scanning Fee
Technology Fee
Total:
Amount
$1.20
$0.40
$100.00
$3.00
$1.60
$106.20
Building Department Copy
Address
Authorized Signature: Owner / Applicant / Contractor / Agent
Parcel Number
Phone
Type of Work: ELECTRICAL
Additional Info: ALARM SYSTEM INSTALLATION
Classification: Residential
Scanning: 1
Amt Paid Amt Due
Pay Date Pay Type
Invoice # EL -7 -10 -38480
07/19/2010 Check #: 6264 $ 106.20 $ 0.00
Applicant
53 NE 101 Street
Miami Shores, FL
1132060131530
Block: Lot:
JORGE RIVAS
1
Valuation:
Total Sq Feet:
July 19, 2010
Date
CeII
JORGE RIVAS
53 NE 101 ST
MIAMI SHORES FL 33181
1
$ 1,277.00
0
Available Inspections:
1
Inspection Type:
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.
July 19, 2010 1
Inspection Number: INSP - 149392 Permit Number: EL -7 -10 -1323
Scheduled Inspection Date: August 02, 2010
Inspector: Devaney, Michael
Owner: RIVAS, JORGE
Job Address: 53 NE 101 Street
Project: <NONE>
Miami Shores, FL
Contractor: ADT SECURITY SERVICES, INC
Building Department Comments
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
LOW VOLTAGE BURGLAR ALARM SYSTEM
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
call before go (305)439 -9000
July 30, 2010
For Inspections please call: (305)762 -4949
Phone Number
co-)
Permit Type: Electrical - Residential
Inspection Type: Final
Work Classification: Alarm
Parcel Number 1132060131530
Phone: (786)331 -3967
Page 24 of 34
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
BUILDING
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: ELECTRICAL
Owner's Name (Fee Simple Titleholder) ` O R`
Owner's Address 5 a ve 10 j c -r City ; 1o6141 sb or e, - State
Tenant/Lessee Name Phone #
Email
Job Address (where the work is being done) 53 ` /6 ) S -e
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL # 1 1 — '32-0 6 -- Ot 3 -- l 5 3
Is Building Historically Designated YES NO Flood Zone
Contractor's Company Name (240
- 6 -‘ 1,111 /one # I ) g —z f
Contractor's Address js 4 2j 4 )
City e State Zip ■6
Qualifier Name
&-e-4 7 /A ii Phone # (t9 L) � 37/
State Certificate or Registration No Q." "/ Zf Certificate of Competency No.
Contact Phone E -mail
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ (1 �'2 2 , 2 Square / Linear Footage Of Work:
Type of Work: DAddition , []Alteration [New 0 Repair/Replace 0 Demolition
Describe Work
Zip
1 /3 ' e-
3U- -
%if; I
' 6
PermitNo. E\ 10 139
***************************************F e *** * *** * *** ** * * * ** ** * * * * * ******* * * ** ***
Submittal Fee $ Permit Fee $ j®I a ®® CCF $ CO /CC $
Notary $ Training/Education Fee $ Technology Fee ,$
Scanning $ Radon $ DPBR $ Bond $
Double Fee $ Violation date:
Structural Review. $ Total Fee Now Due $
See Reverse side -+
i —
Bonding Company's Name (if ap licable)
Bonding Company's Address
City to 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 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 Signature
Sign:
Print:
TA ARY PUBLIC ATE OF FLORIDA
My Commission Expires Alba P guila
Commission #DD682830
` Expires: JULY 26, 2011
BONDE TI3R11 ATLANTIC BONDING CO., INC.
0
APPROVED BY
(Revised 07 /10 /07)(Revised 06/10/2009)
z 4' V Plans Examiner
Engineer
Sign:
Print:
* * * * * * * * * **
My Commission
gent Contractor
The for ent was acknowledged before me thiV% The foregoing instrument was acknowledged before me thi ,
day of ,( 20 l , by , day of , 20 0 , by
who is ersonally known to me or who has produced_ - tt-- who is personally 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: NOTARY PUBLIC:
L G
'U BLIC - STATE OF
A ba A.guila
Commission #DD682830
Expires: JULY 26, 2011
*
Zoning
Clerk checked
CONTRACTORS' REGISTRATION FORM
ALL CONTRACTORS MUST PROVIDE COPIES OF LICENCES AND INSURANCES EACH TIME A PERMIT IS
SUBMITTED OR THE VILLAGE MAY MAINTAIN A FILE WITH YOUR INFORMATION FOR A $30.00 FEE PER YEAR
IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR:
A. COPY OF QUALIFIER'S STATE LIC CARD
B. COPY OF LOCAL BUSINESS TAX RECEIPT
C. COPY OF LIABILITY INSURANCE (CERTIFICATE HOLDER TO BE MIAMI SHORES VILLAGE BLDG DEPTI
D. COPY OF WORKERS COMPENSATION (EITHER CERTIFICATE OR EXCEMPTION)
IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY:
A. COPY OF CERTIFICE OF COMPETENCY OF QUALIFIER
B. COPY OF MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT
C. COPY OF LIABILITY INSURACE (CERTIFICATE HOLDER MUST BE MIAMI SHORES VILLAGE BLDG DEPTI
D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTIONI
YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW:
MIAMI SHORES VILLAGE BLDG DEPT
10050 NE 2ND AVE
MIAMI SHORES, FL 33138
COMPLETE CONTRACTOR'S INFORMATION
BUSINESS NAME: Pt cry
Miami Shores Village
Building Department
BUSINESS ADDRESS: I Mb''VS 3\.1\ CITY \ f'aYXC
STATE \ r ZIP CODE33(:) '
BUSINESS PHONE: 95e--( ( ) 67.---5 /a FAX NUMBER (RS`'t )�\..Q Q ��Fg.
CELL PHONE (957 81 -490 QUALIFIER'S NAME: X ,,ry A
QUALIFIER'S LIC NUMBER:
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
E -MAIL ADDRESS (IF APPLICABLE):
Created on 3119109 BY MLDV 1 RV 3126109 MLDV
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD (850) 487 -1395
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399 -0783
ZACHRY, DAVID J
, ADT SECURITY'SERVICES INC
4381 NW 3RD CT
COCONUT CREEK FL 330€6
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 yvww.myftoridalicense.com.
There you can find more information about our divisions and the regulations that
impact you, subscribe to department newsletters and learn 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!
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND
PROFESSIONAL REGULATION
EF0000478 08/21/08 086001471
CERT ALARM SYSTEM CONTRACTOR I
ZACHRY, DAVID J
ADT SECURITY SERVICES INC
IS CERTIFIED under the provisions of ci .489 Ss
Ix date. AUG. 31, 2010 L08082102108
AG# 3935454
�� yeaE`ty' �• k� °.' 3�:' " ..,;i5 1" _ .. _ '� .c` r .' -z_2a ,. ,n ..: ....1 - - >'
A TE OF IN CERTIFICATE NUMBER
;.: 656487
PRODUCER
Marsh, Inc.
1166 Avenue of the Americas
New York, NY 10036
Telephone (212) 345 -5000
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: Al South Insurance Co.
COMPANY B: Commerce & Industry Ins Co
COMPANY C: Fireman's Fund Insurance Company
COMPANY D: Illinois National Insurance Co.
COMPANY E: Insurance Company of the State of PA
COMPANY F: Nat'l Union Fire Ins Co of Pittsburgh, PA
COMPANY G: New Hampshire Ins. Co.
INSURED
ADT Security Services, Inc.
7747 NW 48th St
Suite 160 Bldg D
Miami, FL 33166 -5407
United States
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 CONDmON 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.
I
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MM/DD/YY)
POLICY
EXPIRATION
LIMITS
G
GENERAL
X
LIABILITY
COMMERCIAL GENERAL
GL 090 - 73 - 63 (Primary GL)
10/1/2009
10/1/2010
GENERAL AGGREGATE
$4,000,000.00
PRODUCTS - COMP /OP AGG
$4,000,000.00
CLAIMS MADE IX
OCCU
PERSONAL & ADV INJURY
$2.000.000.00
OWNER'S & CONTRACTOR'S
EACH OCCURRENCE
$2,000,000.00
FIRE DAMAGE (Any one fire)
$1,000,000.00
MED EXP (Anyone person)
$10,000.00
LLLL LL 1
AUTOMOBILE
X
X
X
LIABILITY
ANY AUTO
HIRED AUTOS
NON -OWNED AUTOS
CA 091-93-98 (MA)
CA 091 -93 -97 (VA)
CA 091 -93 -96 (AOS)
10/1/2009
10/1/2009
10/1/2009
10/1/2010
10/1/2010
10/1/2010
COMBINED SINGLE LIMIT
$7,5500,000.00
<CGWu u.0C 0I
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
THE PROPRIETOR/
PARTNERS/EXECUTIVE
OFFICERS ARE:
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)
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
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
10/1/2010
X I W I I
EL EACH ACCIDENT
$2,000,000.00
EL DISEASE - POLICY LIMIT
$2,000,000.00
EL DISEASE -EACH
$2,000,000.00
G
EXCESSLIABIUTY
X
I OTHER THAN UMBRELLA FORM
UMBRELLA FORM
GL 090 - 73 - 64 (Excess GL)
10/1/2009
10/1/2010
GENERAL AGGREGATE
$11,000,000.00
PRODUCTS - COMP/OP AGG
$11,000,000.00
EACH OCCURRENCE
$5,500,000.00
PROPERTY
0 C) C)
OTHER
Builder's Risk/installation/Contract Works
Rental Equipment/Contractor's Equipment
Blanket Transit
OC 9112860
OC 9112860
OC 9112860
5/1/2009
5/1/2009
5/1/2009
5/1/2010
5/1/2010
5/1/2010
USD 51.000,000.00 per jobsite
USD $1,000,000.00 perjobsite
USD 51,000,000.00 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
I f C1� ..
CANCELLATLOfSl _r N r
CITY OF MIAMI SHORES VILLAGE
10050 NE 2ND AVENUE
MIAMI SHORES, FL 33138
United States
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE
INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER
NAMED HEREIN. BUT FAILURE TO MAIL Slx:F) NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE ISSUER OF THIS CERTIFICATE.
i , ,:,1 1:44.1e«. 14 V ..2-
MARSH USA INC, BY: Franklin Hallack, Global Marine
David Kong. Casualty Program Transit Program
For questions regarding this certificate contact: Alba Gaona (Email: agaona @adt.com Phone: 786 331 3967)
Tax Amount
Transfer Fee
NSF Fee
Penalty
Prior YF Ier COES?
Total Paid
$ 15.00
j
$ 15.00
•
1
;
BROWARD COUNTY LOCAL BUSINESS TAX REC
115 S. Andrews Ave., Rm. A-100, Ft. Lauderdale, FL 33301-1895 -
VALID OCTOBER 1, 2009 THROUGH SEPTEMBER 30,201
DBA
Business Name:
Owner Name:
Business Location:
Business Phone:
Rooms
Numher of Msch
ADT SECURITY SERVICES INC
ZACHRY DAVID J
10785 MARKS WAY
MIRAMAR 33025
(954)917-2374
THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS
THIS BECOMES A TAX RECEIPT
WHEN VAUDATED
MaIIinq Address:
ADT SECURITY SERVICES INC
ZACHRY DAVID J
P 0 BOX 3042
BOCA RATON FL
Seats Employees
57 UNITS
33431-0942
For Vending Business Only
0000015000 0000000000 0000001810003595 1001 6
2009 - 2010
Receipt # 1814I603505
Business Type:
ALARM CONTRACTOR
Busincss Opened:
StatelCounty/Cert/Ress:
Exemption Code:
Machias
02/08/93
EF0000478
NON EXEMPT
Professionals
This tax is levied for the privilege of doing business whist Broward County
and is non-regulatory in nature. You must meet all County and/or municipality
planning and zoning requirements. This Business Tax Rer.elpt must-be-
trnsferred when the bualness is sold, business name has changed or tow_
have moved tie business location. This receipt does not indicate that the
business Is legal or that It is in compliance with State or local laws arid
regulations.
T,T, L:At
n?.
140
0kA.
. 00*
0-- 0
0' "Akie
0,0 .46 0 0.
1
www.sunbiz.org - Department of State
F i3ORII)A - D E, PAR` l'MI:N`I' OF STATE
Home
KOCH, JOHN B
Contact Us
Events Name History
Detail by Entity Name
Foreign Profit Corporation
ADT SECURITY SERVICES, INC.
Filing Information
Document Number P22392
FEI /EIN Number 581814102
Date Filed 01/04/1989
State DE
Status ACTIVE
Last Event MERGER
Event Date Filed 12/31/2001
Event Effective Date NONE
E- Filing Services
Previous on List Next on List Retum To List
Principal Address
ONE TOWN CENTER ROAD
BOCA RATON FL 33486
Changed 04/07/2010
Mailing Address
ONE TOWN CENTER ROAD
BOCA RATON FL 33486
Changed 04/07/2010
Registered Agent Name & Address
C T CORPORATION SYSTEM
1200 SOUTH PINE ISLAND ROAD
PLANTATION FL 33324 US
Name Changed: 04/03/1998
Address Changed: 04/03/1998
Officer /Director Detail
Name & Address
Title PD
Document Searches
Forms
Page 1 of 3
H
Entity Nam
http:// www .sunbiz.org/scripts /cordet.exe? action = DETFIL &inq_doc P22392 &inq... 7/12/2010