ELC-11-1236Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 161850
Permit Number: ELC -7 -11 -1236
Scheduled Inspection Date: July 26, 2011
Inspector: Devaney, Michael
Owner: , SHORES SQUARE INVESTMENTS
Job Address: 9017 Biscayne Boulevard
Miami Shores, FL 33138 -0000
Project: <NONE>
Contractor: WACHTER NETWORK SERVICES INC
Permit Type: Electrical - Commercial
Inspection Type: Final
Work Classification: New
Phone Number
Parcel Number 1132060110070 -17
Phone: (913)541 -2500
Building Department Comments
SATELLITE DISH INSTALLATION
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
c,
July 25, 2011
For Inspections please call: (305)762 -4949
Page 9 of 24
I
Project Address
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
9017 Biscayne Boulevard
Miami Shores, FL 33138 -0000
Owner Information
Parcel Number
Expiration: 01110/2012
Applicant
Address
1132060110070 -17
Block: Lot:
SHORES SQUARE INVESTMENT
Phone
CeII
SHORES SQUARE INVESTMENTS
3850 BIRD Road
MIAMI FL 33146-
Contractor(s) Phone CeII Phone
WACHTER NETWORK SERVICES INC (913)541 -2500 (913)541 -2529
Valuation:
Total Sq Feet:
$ 2,500.00
0
1
Type of Work: ELECTRICAL
Additional Info: SATELLITE DISH INSTALLATION
Classification: Commercial
Scanning: 1
Fees Due
CCF
DBPR Fee
DCA Fee
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Amount
$1.80
$2.00
$2.00
$0.60
$100.00
$3.00
$2.40
Total: $111.80
Pay Date Pay Type
Invoice # ELC -7 -11 -41428
07/14/2011 Credit Card
07/11/2011 Check #: 172673 $ 50.00 $ 0.00
Amt Paid Amt Due
$ 61.80 $ 50.00
Available Inspections:
Inspection Type:
Final
Meter Box
Alteration
Relocation
Fire Alarm
Service Change
Underground
W. W.
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 14, 2011
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
Date
July 14, 2011
1
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
FBC 20
JUL 1 1 2011
Permit No. C 1 1 A
Master Permit No.
Permit Type: Electrical
OWNER: Name (Fee Simple Titleholder): C\�\ 0 ,\ �� Phone#: `‘, :' ,�C7"7C C L \ ‘C\
Address: C \ \ - \LI ,.( \� _��1 \L \ \ \
City: 'k C \ \\ \ 1 -ti V.\ State: C - Zip:
Tenant/Lessee Name: Phone #:
Email:
JOB ADDRESS: C k i,_ \ C.1 R\- LC \LA\ \Z __ " C� \�; C\
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes NO Flood Zone:
CONTRACTOR: Company
Name: \J\\ C 1 \\ C. , \ Phone #: L 1i\\ •2)
Address: A C \C
\ k
City: A _A \ \I\ (\
State: VV-m
Qualifier Name: \\C- \ S
Certificate of Competency #:
( \1 \C \c .V t -\
State Certification or Registration #:
Contact Phone #:C'�\ > ' { I 411 ;( Email Address:
nZip: (.(L( 2_AC "A
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ Square/Linear Footage of Work:
Type of Work: ❑Address ❑Al``teration ❑Ne`w ❑Repair/Replace ❑Demolition
Description of Work: L " eckt \ j \\\,
1 `¢
* **** ******+ x****************+ x*******Fees****** *****+ x******** ****************** ******
u mittal Fee $
Permit Fee $ / ®Wee,
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ Col' fr)
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 c v fled copy of the recorded notice of commencement must be posted at the job site
for the first inspection wh• : occurs s'ven (7 days after the building permit is issued. In the absence of such posted notice, the
inspection will not be ap < oved : ' ion fee will be charged.
I1
The foregoing instrument . cknowledged fo a this
day of �) 3 l� , 20 t 1, by 0( ev1(�..x- a dA
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC
Sign:
Print:
My Commissio E
Signature
actor
The foregoing instrument was acknowledged before me this .n
day of \kC: r !(: , 20 \ 1 ,by :A-\ 0,0 \
who is personally known to me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:: "' 0-i` L 1 LOA LL
Print: - \C \1t V\ (fir \C\ c .
My Commission Expires: BRANDIE FRANCIS
Notary Pic • State of
Zoning
�r
✓� Structural Review Clerk
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
STATE OF FLORIDA
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
ELECTRICAL CONTRACTORS LICENSING BOARD
1940 NORTH MONROE STREET
TALLAHASSEE FL 32399 -0783
BOTTERON, BRADLEY WILLIAM
WACHTER INC
16001 ST 99TH STREET
KS 66219
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.myflorldalicense.com.
There you can find more information about our divisions and the regulations that
impact you, subscribe to department newsletters and leam 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 licensei
DETACH HERE
(850) 487 -1395
BATCH NUMBER ::°
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4,3.4 lr06,i1 :tka�ivrih�'e;x.;; ? 7,4r °�i Fi `�tzr :` <\ §1�fe rf ?l laS l%M1 E1�1+S K CIRElt4i i sti to , !i 4s; sl�rvi% tlac 47R0i4w�t4 l xlbyf
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This License is conditioned upon compliance with all the pnWislOrtS ar440quirelieilit Of th e.X.-aT'-'04' Code
Failure to comply with those provisions may result in revocation of this License THE ISSUANCE OE THIS LICENSE
DOES NOT SIGNIFY CONFORMANCE. WITH ZONING BUILDING OR OTHER CODES AT THE LISTED LOCATION.
BUSINESS LICENSE NUMBER
14257
BUSINESS NAME / MAILING ADDRESS
WACHTER, INC.
16001 W 99TH ST
LENEXA, KS 66219
BUSINESS LOCATION
16001 W 99 ST
LENEXA, KS 66219
. . , . • •
• •
•
Business License Type:
Contractor - Inside Lenexa w/ warehouse
EXCEPT AS LENEXA
Afif 174:077 1741141
LICE
:?N
City of Lenexa / 12350 West 87th Street Parkway / Lenexa, Kansas 66215-2882
913-477-7500 / Fax: 913-477-7730
http://www.ci.lenexa.ks.us
ACCP D®
CERTIFICATE OF LIABILITY INSURANCE81U2o11
DATE (MMIDD/YYYY)
6/16/2011
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 Lockton Companies, LLC -1 Kansas City
444 W. 47th Street, Suite 900
Kansas City MO 64112 -1906
(816) 960 -9000
INSURED
6969
CONTACT
NAME:
PHONE
A/C. No Eat):
MAIL
ADDRESS:
AI . No):
INSURER(S) AFFORDING COVERAGE
NAIC d
WACHTER, INC.
16001 WEST 99TH STREET
LENEXA KS 66219
INSURER A : The Charter Oak Fire Insurance Company
INSURER B : Travelers Property Casualty Co of America
25615
INSURER C : Farmington Casualty Company
INSURER D : Great American Insurance Co of New York
25674
41483
22136
INSURER E :
INSURER F :
COVERAGES WACMA01 V2 CERTIF
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
N
SUBR
wVO
N
POUCY NUMBER JMM/DD/YYYYUMM/DDIYYYYL
DT- CO- 4534M462- COF -10
POLICY EFF
8/1/2010
POLICY EXP
8/1/2011
LIMITS
EACH OCCURRENCE
$ 1.000.000
$ 300,000
$ 5.000
A
GENERAL
X
COMMERCIAL
LIABILITY
GENE BILITY
DAMAGE TO RENTED
PREMISES (Ea occurrence)
CLAIMS -MADE
X
OCCUR
MED EXP (Any one person)
X
X
GEN'L
7
RR EXCL. DELETED
PERSONAL & ADV INJURY
$ 1,000,000
CONTRCTUAL, X -LIAB.
GENERAL AGGREGATE
$ 2.000.000
$ 2.000.000
$
AGGREGATE LIMIT um PER:
POLICY n JECT I I L
PRODUCTS - COMP /OP AGG
B
A
AUTOMOBILE
X
X
LIABILITY
ANY AUTO
ALL OWNED
AUTOS
HIRED AUTOS
X
SCHEDULED
AUTOS
NON -OWNED
AUTOS
PHYS DAM
N
N
DT8104534M462T1L10 AOS
DT8102788C97ACOF10((TX))
8/1/2010
8/1/2010
8/1/2011
8/1/2011
COMBINED SINGLE UMIT
accident)
$ 1.000.000
$ jaMM
$ XXXXXXX
BODILY
BO INJURY (Per person)
BODILY INJURY (Per accdent)
PROPERTY DAMAGE
(Per accldentl
$ XXXXXXX
Comp /Coll Deds.
$ 1,000
D
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
N
N
UMB 8635031
8/1/2010
8/1/2011
EACH OCCURRENCE
$ 2,000,000
$ 2.000.000
$ XXXXXXX
AGGREGATE
DED
1 RETENTION $
C
AND WORKERS LOYERS' LIABILITY Y/ N
OFFICER/MEMBER EXCLUDED? /EX
XCLUDED ECUTIVE N
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
N
DTSUB4534M46210
8/1/2010
8/1/2011
X
ITORY LiMITSI
IOER
E.L. EACH ACCIDENT
$ 1.000.000
$ 1,000,000
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE - POUCY UMIT
DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
CERTIFICATE HOLDER
CANCELLATION
11305921
MIAMI SHORES VILLAGE BUILDLING DEPARTMENT
10050 N.E. 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
ACORD 25 (2010/05)
The ACORD name and logo are registered marks of ACORD 01988 -2010 CORPORATION. All rights reserved