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EL-11-1120Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 161321 Permit Number: EL -6 -11 -1120 Scheduled Inspection Date: June 27, 2011 Inspector: Devaney, Michael Owner: THOROGOOD, DANIEL Job Address: 635 NE 105 Street Miami Shores, FL Project: <NONE> Contractor: FLORIDA BURGLARY CONTROL INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number Parcel Number 1122310120070 Phone: (305)965 -4064 Building Department Comments BURGLAR ALARM 3a1- -6por Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments June 24, 2011 For Inspections please call: (305)762 -4949 Page 27 of 34 uktiAtk- 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.4E L BUILDING PERMIT APPLICATION FBC 20 JUN 2 1 Ra'oe} Master Permit No. `A 47 Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): 0/2. /c-749-1.../ f a.?(go oc, Phone #: Address: (, 3 5 /J E /0,5 S ` City: �� a-j, ` 54 E S State: , , C Zip: 33/ 3<1 Tenant/Lessee Name: Phone #: Email: 32/- {S23 JOB ADDRESS: 63_5- sv /OS City: Miami Shores Folio/Parcel #: O/2— ® 00 -747 County: Miami Dade Zip: 3-3/ 3 g • Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 'f \ o r t ! �' Address: i..ta City: Qualifier Name: State Certification or Registration #: Contact Phone #: DESIGNER: Architect/Engineer: (V\1 c 1kk'� State: '...1.1z.d'l V P rCv'r (;hone#: 1'1'C cis ©� /Xa Email Address: —V51 52C4 9g,S y zip: 33C)/ Phone #: 9,5 / -558-C.900 Certificate of Competency #. L ce.(n (Nur\cVC 7.51`Nry (-14-ad vcotil Phone #: Value of Work for this Permit: $ �/'5�` * Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration Tew ❑Repair/Replace ❑Demolition taa /� Description of Work: ******** *k * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** r Submittal Fee $ -) " Permit Fee $ /41e' ' '' CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signatures 0--- �� Owu r or Agent Contractor The foregoing instrument was acknowledged before me this The fore + trument was acknowledged before me this day of , . l , 20 i d , by 6 , 4 , 1 4 i : . , % 4 ,v f o o d , day of . 1 , 20 I? , by J16 ilckLi) / /10-ev Z. who is personally known to me or who has produced 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 PUB C: Sign: Print: My Commission Expires: CARMEN B. URQUIZA Notary public, Stated' Commission •DD841027 My Commission Wins Nov. 24,2012 Si P CARMEN B. URQUIZA State of Florida CommiSgE• ^.- nn.+,. ^tn27 My Commission Expires: kdeo4•Ie4:***kkdea'e** **k ** * ***9e* oY:Y*:****** ***** * **k* ** **YY*4c4e9e9e9c* YkoYoY9e*aYoY**** **kk Y** * ********* *** * *: *k3r*** APPROVED BY, " ✓� `� 104—"ef, Plans Examiner Zoning Structural Review Clerk (Revised 07 /10 /07XRevised 06 /10 /2009)(Revised 3/15/09) Jun. 20. 2011 4:13PM Gil Garden Avetrani No. 2046 P. 1/1 AWR° CERTIFICATE OF LIABILITY INSURANCE 1 6/20/20 1 ' 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 paIlcy(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 Gil, Garden, Avetrani Insurance Group 10689 N. Kendall Drive Suite 208 Miami FL 33176 NANTACT Marta Barrionuevo "ME , ti. (305) 630 -4777 I Nol (305i279 -9099 AD ss.martabBggaig.com CUST 1De00002012 INSURER(S) AFFORDING COVERAGE NAIC # INSURED Florida Burglary Control, Inc. 17675 NW 91st Court Miami FL 33 018 lasuRERA:Alterra Excess & Surplus Inc.Co INSURER B: 6/9/2011 INSURER C: EACH OCCURRENCE INSURER D: DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER E : INSURER F : 8 5,000 COVERAGES CERTIFICATE NUMBER:CL116201728 • THIS IS TO CERTIFY THAT THE POLICES 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. ILTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MIEUoo1YYYY) (MOO/MY) LIMITS A GENERAL X UASUTY COMMERCIAL GENERAL LIABILITY ICLAOdSMADE IXIOCCUR ERRORS & OMIIZSSIONS IBA 6/9/2011 6/9/2012 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100, 000 mu, EXP(Anr one person) 8 5,000 X GEMLAGGREGATE B 1 PERSONAL IL ADV INJURY $ 1,000,000 INCLUDED GENERAL AGGREGATE $ 2,000,000 LIMIT APPLIES POLICY I� ,ITT PER: —I . PRODUCTS- $ 2,000,000 8 AUTOMOBILE UABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMB (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB — OCCUR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION EMPLOYERS' LIABILITY Y / N ANY PROPRIETORUPARTNER/EXECUTIVE OFFICERUMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A I LIMITS I I OTH- TORY lN ER El. EACH ACCIDENT $ EL. DISEASE- EA EMPLOYEE $ EL. DISEASE - POLICY LMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule. I mare space 1e required) CERTIFICATE HOLDER VILLAGE OF MIAMI SHORES 10050 NE 2ND AVE MIAMI SHORES, FL 33138 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 - - -..,,,, .. S Rodriguee/MMB ' _ - ^ , • • ACORD 25 (2009/09) INS025 (30909) O 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD