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EL-11-903Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 162431 Permit Number: EL -5 -11 -903 Scheduled Inspection Date: July 26, 2011 Inspector: Devaney, Michael Owner: HENDRIX, TODD Job Address: 210 NE 102 Street Miami Shores, FL 33138 -2427 Project: <NONE> Contractor: DEVCON SECURITY SERVICES CORP Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number (305)915 -4899 Parcel Number 1132060480010 Phone: (786)845 -9661 Building Department Comments REPAIR AND REPLACE BURGLAR ALARM Passed Failed Correction Needed Re- Inspection Fee • Inspector Comments No Additional Inspections can be scheduled until re- inspection fee is paid. 1/ /& pYi 7a7� July 25, 2011 For Inspections please call: (305)762 -4949 Page 14 of 24 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Parcel Number Applicant 210 NE 102 Street Miami Shores, FL 33138 -2427 1132060480010 Block: Lot: TODD HENDRIX 1 Owner Information Address Phone cell TODD HENDRIX 210 102 Street MIAMI SHORES FL 33138- (305)915 -4899 Contractor(s) Phone DEVCON SECURITY SERVICES CORP (786)845 -9661 Cell Phone Valuation: Total Sq Feet: $ 668.00 0 1 Type of Work: Additional Info: Classification: Residential Scanning: 1 Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee - Additions/Alterations Scanning Fee Technology Fee Total: Amount $0.60 $2.00 $2.00 $0.20 $100.00 $3.00 $0.80 $108.60 Pay Date Pay Type Invoice # EL -5-11 -40968 05/17/2011 Check #: 4345 05/19/2011 Check #: 4339 Amt Paid Amt Due $ 50.00 $ 58.60 $ 58.60 $ 0.00 Available Inspections: Inspection Type: 1 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. May 19, 2011 Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy Date May 19, 2011 1 51 Let lk 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 : •••• MM 1 7 2011 BUILDING PERMIT APPLICATION FBC 20 Permit Type: ELECTRICAL Owner's Name (Fee Simple Titleholder) / PO ff � Permit No. EL 6 Ct Master Permit No. Owner's Address Phone # 3°5 - 94s - G/89% City /frt/A- f"'1 5/1' ; State Zip 5? /1f Tenant/Lessee Name Phone # Email Job Address (where the work is being done) 20a 2__ / City Miami Shores Village County Miami -Dade Zip ;-5 /Sr FOLIO / PARCEL # // ® J� " ' ''r Ob /a Is Building Historically Designated YES NO ®Flood Zone Contractor's Company Name ¶ NWJr-) C U0.: N- Phone # ( 5 9 5c4- , Contractor's Address � City '\ State Zip S x ` �(b Qualifier Name c)C`s)-e(2-3 Q -CV2 Phone # 5 .--� State Certificate or Registration No. V Certificate of Competency No. Contact Phone Architect/Engineer's Name (if applicable) E -mail c-CNrve cor)— �c�,��c Phone # Value of Work For this Permit $ “:7 ‘01"S Square / Linear Footage Of Work: Type of Work: :Addition &AAllteration :New Repair/Replace 0 Demolition Describe Work: •� �� c`— \�� N * ** * * * *.* * * * * * * * *** * * * * * * * * * * * * * * * * * *, Fees************* * * * * * * * * * * * * * * * * * * *x * * * * * * * * * ** won Submittal Fee $c-�. p 0 Permit Fee $ / CCF $ CO /CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ S. r • 0 See Reverse side -> 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 $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be pproved and a re- inspection fee will be charged. Signature G' — Signature 111/4111 Pc Owner or Agent Contractor The foregoing instrument was acknowledged before me this 11 The foregoing instrument was acknowledged before me this VA- day of k 01._t , 20 It , by 1O1DD rtc..4■1Y -1)C , day of , 20 1 , by who is personally known to me or who has produced ID who is p As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: �n1��y Pt1911� E OF �r�Y�Y�:,: 3c: �iede�r� :nY:Y *�YaY3r�Y�r�+r�c3r*** .+4...**** 4/ i4i17' 11 4Mai: Je` *k :Yir****sY**,F*3caY**3e: *** *,k******9c*3c**3ek* Yee, k**, k*: F, Ya': 3r*de3raY*9r***3e*d :,+rsh*** 22 /( 4-4Ians Examiner Zoning o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: My Commission ate`r Notary Public State of Florida Carlos Mercado 4; My Commission 130706637 Expires 08/20/2011 APPROVED BY Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Clerk checked SEE OTHER SIDE DO NOT FOR WARD DEVON SECURITY SERVICES CORP ROBERT FARENoEfl PRES 3880 N 28 TERR HOLLYWOOD FL 33020 lau,il;llunam ll +.11.t)llnu.1I1ti1Ala ACORI$ CERTIFICATE OF LIABILITY INSURANCE `.....--- 2/28/2012 DATE(MM/DD/YYYY) 2/24/2011 THIS CERTIFICATE 15 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 Lockton Insurance Brokers, LLC CA License #0F15767 Two Embarcadero, Suite 1700 San Francisco 94111 (415) 568 -4000 CONTACT PHONE I FAX C. (NC. No): E�) ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Lexington Insurance Company 19437 INSURED Devcon Security Services Corp. 1321615 3880 N. 28th Terrace Hollywood FL 33020 INSURER a :United States Fire Insurance Company 21113 38318 INSURER c : Starr Indemnity & Liability Company INSURER D : United States Fire Insurance Co. EACH OCCURRENCE INSURER E : GE TO RENTED PRREM SES (Ea occurrence) INSURER F : COVERAGES DEVHO01 DE CERTIFICATE NUMBER: 10806324 XXXXXXX 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 ADDL INSR SUBR W VD POUCY NUMBER POLICY EFF (MM/DDIYYYY) POLICY EXP (MMIDD(YYYY) LIMITS A GENERAL X UABIUTY COMMERCIAL GENE' :ILITY N N 64199373 -01 2/28/2011 2/28/2012 EACH OCCURRENCE $ 1,000.000 $ 500,000 GE TO RENTED PRREM SES (Ea occurrence) CLAIMS -MADE X OCCUR MED EXP (Any one person) $ Excluded X X GEN'L -1 $5K ded. per occur PERSONAL & ADV INJURY $ 1,000,000 E&O $1mil per occur GENERAL AGGREGATE $ 2.000.000 $ 1.000.000 $ AGGREGATE POLJCY LIMIT APPLIES I AI 178-r" PER Ft LOC PRODUCTS - COMP /OP AGG B •AUTOMOBILE X X _ UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SCHEDULED AUTOS NON -OWNED AUTOS N N 133 - 7306934 2/28/2011 2/28/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1.000.000 • BODILY INJURY (Per person) $ XXXQCX BODILY INJURY (Per accident) $ VOODOO( PROPERTY DAMAGE /Per accident) $ X �CXXX $ X(700 X C _ J{ UMBRELLA L1A13 EXCESS LIAB X OCCUR CLAIMS -MADE N N SISCSEL00001711 2/28/2011 2/28/2012 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10.000.000 DED RETENTION $ $ XXXXXXX D WORKERS COMPENSATION AND EMPLOYERS' maim? ANY IE ERPARTNEFUE ECUTIVE (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N /A N 408- 701848 -5 2/28/2011 2/28/2012 WC STATU- (TORY LIMITS! X I OTH- ER E.L EACH ACCIDENT $ 1.000,000 $ 1,000,000 E.L DISEASE - EA EMPLOYEE E.L DISEASE - POLICY LIMIT $ 1.000.000 • DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION 10806324 VILLAGE OF MIAMI SHORES 10050 NE 2ND AVENUE 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 POUCY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ©1988 -2010 ACORD CORPORA'. • N. All rights reserved