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ELC-11-1649Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 164252 Scheduled Inspection Date: September 21, 2011 Inspector: Devaney, Michael Owner: LLC, MSVC Permit Number: ELC -9 -11 -1649 Job Address: 9472 NE 2 Avenue 9472 Miami Shores, FL 33138 -0000 Project: <NONE> Contractor: BURGLAR ALARM SERVICES INC Permit Type: Electrical - Commercial Inspection Type: Final Work Classification: Addition /Alteration Phone Number ()- Parcel Number 1132060132780 -72 Building Department Comments BURGLAR ALARM INSTALLATION Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments September 20, 2011 For Inspections please call: (305)762 -4949 Page 23 of 34 9N�)� 1\4FZ, 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 Permit Type: Electrical `� t ` OWNER: Name (Fee Simple Titleholder): t/& Address: '.3l® RC U4 wen Otr Aj'to lit? 11°1/34 City: Permit No. SEP � a 2019 Master Permit Noe.. C, 3 // LL. Phone #: Q6� �' q •d Tenant/Lessee Name: 1 A. l b4s NIA Email: 1 @ s 1.4114411 '-i State: ( Zip: 3020 -13 a L.4G1 er— Phone #: 146 ° S69 - 7 Zip: are% ! 1 y A1-0 N 1 M.1•1 t. • Gorr► JOB ADDRESS:Sa o n a �i 1 + q q1-t7 p., me. and VP City: Miami Shores County: Miami Dade Folio/Parcel #: 0// — 3 Z cy ©/ 3 2 7g? 0 3P3 Is the Building Historically Designated: Yes NO ) Flood Zone: CONTRACTOR: Company Name: BURGLAR ALARM SER1/I y INC. Phone #: 5650 SHERIDAN ST Address: H011YW00D FL 33021 -3250 City: P 959.963..3366 Zip: Qualifier Name:SPtJce-#.i 4 k i c S Fax: 9 -981 -4302 Phone#: State Certification or Registration #: 6 ,F Q 000 °ta gi Certificate of Competency #: Contact Phone #.9;r9 - 96,y - 3 3 cc Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Z,� Square/Linear Footage of Work: Type of Work: ❑Address DAlteration ew ORepair/Replace ODemolition Description of Work: ,g ,r rr *** *: x**** ******* **+x+x****** ****** ****** Fees **+x*****.r**** ******* * ************ ***** Submittal Fee $ Permit Fee $ /0)0 P CCF $ CO /CC $ Scanning Fee $ Radon Fee $ D$PR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE s cc Bonding Company's Name (if applicable) Bonding Company's Address City State Zip it Mortgage Lender's Name (if applicable) V iV 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 COND1TIONERS, 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 COMMENCEMENTS" 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. Signature e Owner or Agent The foregoii�' ��h st ument was acknowledged before me this day of5 k ,20 /I , by Y L. sithr who is personally known to me or who has produced As identification and who did take an oath. DeitaEUNE TORRES NOT - Y PUBUC OF FLORIDA EE1181357 NOTARY P Sign: Print: Contractor The foregoing instrument was acknowledged before me this day of _ ser , 2011, by 6\n,c� L- E}n }c� [CtS, .S who is known to or who has produced as identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: * * * * * * * * * * * * * * * * ** APPROVED BY * * * * * * ** NONAER MY COMMISSRIi4IY pit . EXPIRES Jiff qsi (407)3,98-0153 Fbridallot vfp 5 IkAl • Oc Expires: 0 co-a-6-13 * w+ x***+ x+ u+ x+ u***s:+ xa: *s:********* ****+ x******** *x** * **+x+x,***** ** ** * *** *** ** ****** ** Plans Examiner Zoning Structural Review (Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk 6-5 ® CERTIFICATE OF LIABILITY INSURANCE ANC E I NCF Insurance Associates 1700 West Flagler Street #320 Miami FL 33174 Phone:305- 446 -5474 Fax :305- 444 -8796 INSURED Burglar Alarm Services, Inc. Bruce L. Street Hollywood FL 33021 COVERAGES OP ID OG BURGL -1 DATE (MM/DD/YYYY) 08/24/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION • ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: Scottsdale Insurance Co . NAIC # INSURER B: Lloyd' s of London INSURER C: INSURER D: INSURER E: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INbH AUU L LTR INSRC A TYPE OF INSURANCE GENERAL LUABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE I X I OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT ^ LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS POLICY NUMBER CPS1313312 POLICY MDD YYYY) 01/03/11 POLICY EXPIRATION DATE (MM/DD/YYYY) 01/03/12 LIMITS EACH OCCURRENCE UAMAMMt I U HtN I tU PREMISES (Ea occurence) $1,000,000 $100,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP /OPAGG $1,000,000 $2,000,000 $1,000,000 GARAGE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EXCESS / UMBRELLA LIABILITY OCCUR I CLAIMS MADE DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIV OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes describe under SPECIAL PROVISIONS below OTHER AUTO ONLY - EA ACCIDENT OTHER THAN AUTO ONLY: EA ACC EACH OCCURRENCE AGG AGGREGATE Y/N (TORY LIMITS I ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE Property w /Wind 5% wind ded E.L. DISEASE - POLICY LIMIT LEW -2086 $1000 ADP DED DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Certificate holder is additional insured with respects to General Liability when required by contract. 08/16/11 08/16/12 Building 200,000 CERTIFICATE HOLDER Contents 30,000 CANCELLATION MIAMI SHORES VILLAGE 10050 NE 2ND AVENUE MIAMI SHORES FL 33138 ACORD 25 (2009/01) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR UABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHOR REPRESE,pQAT1V !}��' /�/ COR deal-2009 ORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AR°1 CERTIFICATE OF LI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEN BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTI REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, th the terms and conditions of the policy, certain policies may require an certificate holder In lieu of such endorsement(s). PRODUCER Doug Jones c/o AJG Risk Management Services, Inc. 8800 E. Chaparral Rd, Suite 230 Scottsdale, AZ 85250 INSURED Oasis Acquisition, Inc Alt. Emp: BURGLAR ALARM SERVICES, INC. 2054 Vista Parkway Suite 300 West Palm Beach, FL 33411 COVERAGES CERTIFICATE NUMBER: 11 FL075729 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEOD ABOVEB OR THE POLICY PERIOD ER: 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 ILTRR ADDL SUER INSR 111/VD POLICY NUMBER ABILITY INSURANCE I DATE(MM/DD/YYYY) 06/21/2011 LY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS D, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES TOTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED e policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to endorsement A statement on this certificate does not confer rights to the CONTACT NAME: rat . Ex0: (480) 951 -4177 FAx (a/c, No): (480) 9514266 ADDRESS: INSURERS) AFFORDING COVERAGE NAIC # INSURERA: Zurich - American Insurance Company 16535 INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : J89 TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I I OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POUCY : E T LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAB EXCESS UAB (PLO DINYYTy (MOM//DD YYYY) EXP LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) OCCUR CLAIMS -MADE A DED RETENT ON $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below EACH OCCURRENCE AGGREGATE N/A WC 29-38- 687 -09 06/01/2011 06/01/2012 Location Coverage Period: 06/01/2011 06/01/2012 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) Coverage is provided for BURGLAR ALARM SERVICES, INC. only those employees 5650 Sheridan St leased to but not HOLLYWOOD, FL 33021 subcontractors of: CERTIFICATE HOLDER MIAMI SHORES VILLAGE 10050 NE 2 AVENUE MIAMI SHORES, FL 33138 CANCELLATION WC STATU- OTH- X TORY LIMITS I I ER E.L EACH ACCIDENT EL DISEASE - EA EMPLOYEE EL DISEASE POLICY LIMIT Client#: 1362 -MAIN $ $ 1,000,000 $ 1,000,000 1,000,000 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) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD TYPE OF INSURANCE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I I OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POUCY : E T LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS HIRED AUTOS UMBRELLA LIAB EXCESS UAB (PLO DINYYTy (MOM//DD YYYY) EXP LIMITS EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG $ SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) OCCUR CLAIMS -MADE A DED RETENT ON $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below EACH OCCURRENCE AGGREGATE N/A WC 29-38- 687 -09 06/01/2011 06/01/2012 Location Coverage Period: 06/01/2011 06/01/2012 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more apace Is required) Coverage is provided for BURGLAR ALARM SERVICES, INC. only those employees 5650 Sheridan St leased to but not HOLLYWOOD, FL 33021 subcontractors of: CERTIFICATE HOLDER MIAMI SHORES VILLAGE 10050 NE 2 AVENUE MIAMI SHORES, FL 33138 CANCELLATION WC STATU- OTH- X TORY LIMITS I I ER E.L EACH ACCIDENT EL DISEASE - EA EMPLOYEE EL DISEASE POLICY LIMIT Client#: 1362 -MAIN $ $ 1,000,000 $ 1,000,000 1,000,000 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) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BROWARD COUNTY LOCAL BUSINESS TAX RECEIPT 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 — 954- 831 -4000 VALID OCTOBER 1, 2011 THROUGH SEPTEMBER 30, 2012 DBA: Business Name: BURGLAR ALARM SERVICES INC Owner Name: BRUCE L HOTCHKISS Business Location: 5650 SHERIDAN ST HOLLYWOOD Business Phone: 954- 981 -4300 Rooms Seats Employees 2 Receipt #:181 -3358 Business Type'ELECTRICAL /ALARMS /CONTRAC '(FIRE ALARM SPEC ELECTRIC Business Opened:03/21/1986 State /County /Cert/Reg:EP 0 0 0 0 2 2 8 Exemption Code:NONEXEMPT Machines Professionals Number of Machines: For Vending Business Only • Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 27.00 0.00 0.00 0.00 0.00 0.00 27.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non - regulatory in nature. You must meet all County and /or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has changed or you have moved the business location. This receipt does not indicate that the business is legal or that it is in compliance with State or local laws and regulations. Mailing Address: BRUCE L HOTCHKISS 5650 SHERIDAN ST HOLLYWOOD, FL 33021 -3250 2011 - 2012 Receipt #01A -10- 00010477 Paid 08/29/2011 27.00 FLOR CLASS: E SAFE DRIVER � yz 0] -08 -9 1.1 -10 -97 TOY ALSO D0 -00 -00 17. R0792034401 - FLORIDA DRIVER'S LICENSE OR IDENTIFICATION CARD EXTENSION RESTRICTION CODES CORRECTIVE LENSES N HEARING AID 5. 000910E REARVIEW MIRROR L SEAT CUSHION C. BUS1NESS PURPOSES - M NANO CONTROL OR PEDAL EXTENSION 0: EMPLOYMENT PURPOSES 0. LEFT FOOT ACCELERATOR E DAYLIGHT O°10180 ONLY -IP P90091109 INTERLOCK DENICE E. AUTOMATIC TRANSMISSION S OTHER RESTRICTIONS 0 POWER STEERING':'. ''T NO PASSENGER ON MOTORCYCLE. OMECTIONAL SIGNALS -X MEDICAL ALERT BRACELET J. C919ON 0090911G WHEEL V. EDUCATIONAL PURPOSES EO 0: 0,9.0.08 EXE U'M19 019ECT0R 0090 OF ■!0140990 SAF?Y ANC 0709 VEH!CL ES 0 , 4 4 9 1 0 ' 09 4 9 09 9 4 1 9 1 0 9 4 01 0 0 0r RIR'4TS MEREl9 °kj# EXPIRESDN' BIRTHDAY: 2 1 1 `UOIT NO 6tG9OQ3 CLASS: ENDORSEMENT E COMMERCIAL EMERGENCY VEHICLES F.'. COMMERCIAL FARM VEHICLES IC,ALSO 2 1-0