Loading...
EL-11-1135Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 165183 Permit Number: EL -6 -11 -1135 Scheduled Inspection Date: October 06, 2011 Inspector: Devaney, Michael Owner: CLAY, MICHAEL & GENEVIEVE Job Address: 141 NE 109 Street Miami Shores, FL 33161- Project: <NONE> Contractor: SAFE STREETS USA Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number 305 - 756 -9832 Parcel Number 1121360040520 Phone: (813)514 -2693 Building Department Comments LOW VOLTAGE BURGLAR ALARM Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments CREATED AS REINSPECTION FOR INSP- 162777. CREATED AS REINSPECTION FOR INSP- 162729. No one home No one home 4:22 pm.. October 05, 2011 For Inspections please call: (305)762 -4949 Page 20 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 141 NE 109 Street Miami Shores, FL 33161- 1121360040520 Block: Lot: MICHAEL & GENEVIEVE CLAY Owner Information Address Phone Cell MICHAEL & GENEVIEVE CLAY 141 NE 109 Street MIAMI SHORES FL 33161 305 - 756 -9832 Contractor(s) SAFE STREETS USA Phone Cell Phone (813)514 -2693 Type of Work: LOW VOLTAGE ALARM 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 Invoice # 06/22/2011 07/20/2011 Pay Ty e EL -6 -11 -41273 Check #: 2235 Check #: 2329 Amt Paid Amt Due $ 50.00 $ 58.60 $ 58.60 $ 0.00 Available Inspections: 1 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. Authorized Signature: Owner / Applicant / Contractor / Agent Building Department Copy July 20, 2011 Date July 20, 2011 1 'I 1I 11 Can ^+e Villa Miami Shores Village g Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 JUN 2 2 2011 Permit No. t 1 1 35 Master Permit No. Permit Type: Electrical J1 2 �� /� qr� Owner's Name (Fee Simple Titleholder) f 1t CAN Phone # 3O5 • �'JLD• ` IS i Owner's Address 1_4114 •E...' 14 • 101 . city to ■a k cfZS State .. Zip S'?"1 Ltr 1 Tenant/Lessee Name Phone # E- MAIL: h��, Job Address (where the work is being done) N 1 1 * E 10 City Miami Shores Village County Miami -Dade FOLIO / PARCEL # 1 1- .13LD• ( Is Building Historically Designated YES NO Contractor's Company Name fx ^ nw SI li 1 S USFI Contractor's Address • Y City IN—/LTA-7_ ` r �^ ,State L. Qualifier Name V V I 1 j 1 Q VIII Pe.Ct POCK State Certificate or Registration No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # • Zip S3I Le I Phone # Zip �3 Phone # �sl'3.610 -Qu ? Certificate of Competency No. Value of Work For this Permit $ 1111-1.00 Type of Work ['Addition ['Alteration Describe Work: Square / Linear Footage Of Work: e ❑ Repair/Replace 0 Demolition • * * * * **, *** * ** **Irk ** t *** *a* *** ****rte► * *F * * *+ *rr******* ** * * *** **Ik * * * * * * * * ** * ****** *** Submittal Fee $50-C° Permit Fee $ l' a' - '' ` CCF $ CO /CC raining/Education Fee $ Technology Fee $ Radon $ DPBR $ Zoning $ Code Enforcement $ Double Fee $ Total Fee Now Due $ See Reverse side -4 Notary $ Scanning $ Bond $ Structural Review. $ 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 OIMPROVEMENTS O UAO INTEND FINANCING, CONSULT WIH YOUR LENDER OR AN ATTORNEY BEFORE RECRDDING OUR NOTICE OF COMMENCEMENT." Notice to Applicant: Asa 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 subj . t to ,,, , . % t. A1sG, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspectio ` hich (7) days after the building permit is issued In the absence of such fppsted notice, the inspection will not be lion fee • be charged. y1/ AAA Agent 4 Owner or f_' The foregoing instrument was acknowledged before me this t T day of J I ic„ 20 iL by M. UCJ1 .t C 1 who is personally known to me or who has produced L. As identification and who did take an oath. NOTARY PUBLIC: JENNIFF,R A. MANSFIELD Signature 1 Contractor The for oing instrument was a acknowledged before me this n '�,��bb day o 20 by e[A:l� who is personally known to me or who has produced 4:51 as identification and wiR r `' NOTARY PUBLIC• '' NOTA Y FUE STA OF F•L ilk Dot NOT Y-�- /. jj Sign : I ! J i ai•� , all � ; . , sign: Print: CtJ,a :k1-0Mrli►`' i% IT Print: My Commission Expires: g 1 My Commission Expires: A fib IL/ APPLICATION APPROVED BY: J (Revised 02/08/06) Plans Examiner Engineer Zoning 04/19/2011 10:50 8138069693 PERMITTING Alanrireani To:. in la DI-1 Spa's Fax:. a ? Phone: Re: n'p ) eata.fecek i From: Or Pages: Date: LI 14 .J 1 j Urgent For Review Please Comment Please Reply Please Recycle Comments: • WI Low' h tatu na u,c� ' y u 44/2)Le co/ tut() CbWilteAd4, fr AP tnaii 0.9([11:1 LLbap. PAGE 01/07 . • Otn-i-oia-1- 6/1_ t-rb X613- 6 .A3 gist, WO- take `-+vcildem h+een caSak-l-reefs..eoar 16105 N. Florida. Ave., Suite F, Lutz, FL 33549 Office: 813 -514 -2693 Fax: 866 - 4201216 04/19/2011 10:50 8138069693 PERMITTING PAGE 02/07 Miami Shores Village Building Department LOiDI= 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 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 DEP 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 DEPT) D. COPY OF WORKER COMP INSURANCE (EITHER CERTIFICATE OR EXEMPTIONJ YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE HOLDER AS FOLLOW: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 BUSINESS NAME: COMPLETE CONTRACTOR'S INFORMATION Lt LLCL BUSINESS ADDRESS: 11.005 )4 \(f)l'i t (.1;- CITY L LA Z STATE SL ZIP CODE 3311---((3 BUSINESS PHONE: (`b13) 611.1. i,,Q% FAX • NUMBER (1) . 4 )' 1 - f p CELL PHONE O QUALIFIER'S NAME: ' 1 l C 7 1 eL. • QUALIFIER'S LIC NUMBER: ✓ �� 1 ? k-I DL! E -MAIL ADDRESS (IF APPLICABLE):.+Va r m he.‘0n Sr6__J.1 'Q tS Croated on 3119109 BY MLDV 1 RV 3126109 MLDV 04/19/2011 10:50 8138069693 PERMITTING PAGE 03/07 mum= NT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD 1940 • NORTH MO1mROg STREET TALLAHASSEE FL 32399 -0783 PEACOCIC NYLLIAM ALAN SAPS STREETS USA LLC 5305 YNOR ROAD SUITE 100 GARNER 529 Congratulations! With this Donne you become one of the nail one million Floridians licensed by the Depactmantof Business and Proteesbnal Regulation. Our professionals and businesses range from architects to yacht brokers, from boxers to barbeque restaurants. and they keep Ftot'tde's economy strong. Every day we work to Improve the way we do business in order to eerve you better. For information about our services, please log onto www.m,ftridalIcenter.com. There you can Lind more Information about our divismns and the.regutations that Impact tyyomu,�s subscribe to department newsietiers and leant more about the constantly strive o servo you so � you canyse serve a your Regulate Fairly, Beres. Thank you for doing business In Florida. and congr�la0ons o your new license! DETACH HERE (850) 487 -1395 MArOOFPL OM AC# $5298211 DEPARTJORIT__AY BUSI113BS AND PROPESSI REGULATION EO13000404 03/21/21.1Q033.0716 CSR' ALARM SYSTEM CONTRACTOR 1`I 9RACSCa, WXLLThX ALAN SAFE STREETS USA LLC 1.5 CERTITstro i dor rlu provisioao of ci .4Ua is • Itz.tioa st. 3]. 2012 =Minim U • 5529828 mo DAIt . ��ppSTATE OF FLORIDA DEPARTgameaSs SS C7'OYiBRassimpaRA Tzon SEW :41032200831 E3A T cH NUMHER 03/21 /2011 10037.0716 NO13000404 The ALARM SYSTEM COMTRACTOR Ix Named below XB CERTIFIED Under the provisions of Chapter 489 FS. Elxpirat:ion date, AUG 31, 2012 PEACOCK, SAFE __WILLIAM ALAN 5305 YNOR ROAD SUIZEC1005a9 • RICE SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW CEARLZIS • 04/13/2011 10:50 8138069693 PERMITTING HILLSBOROUGH COUNTY BUSINESS TAX RENEWAL INSTRUCTIONS Chapter 205.0535 (5) Florida Statutes requires one of the following: FEDERAL EMPLOYER IDENTIFICATION NUMBER OR SOCIAL SECURITY NUMBER _ PAGE 04/07 1. SIGN and return entire form in enclosed envelope. Your validated Business Tax receipt will be returned to you. 2. Business Tax receipts expire midnight, September 30th. Failure to display a valid Business Tax receipt after September 30th is a violation of Hillsborough County Ordinance 95-4, as amended by 02 -5. MAKE CHECK PAYABLE TO: DOUG BELDEN, TAX COLLECTOR • P O Box 172920 • TAMPA, FL 33672 -0920 2010-2011 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT 1 FACILTrni OR MACHINES 1 Rooms 0' 1 SEATS LATE • RY CODE BUSINESS TYPE 280.000 PUB C SERVICE -ALARM SYSTEMS BUSINESS LOCATION LU .r. 335 NAME SAF. MAILING 5 ADDRESS 16105 N FLORIDA AVE F BUSINESS TAX HAS MEW PAW A PRIVI.EGE TAZ To ENGAGE IN BUSINESS. pROfJiasION. OR OCCUPATION Mara g, HEREON. EXPIRES 9-30 -2011 POLIO No. 161 1 TRANSFER' I 243108 H. WASTE TAX suRCHARGE 005-2 0 1 1 DOUG BELDEN. TAX COLLECTOR 913435 -5200 THIS BECOMES A TAX RECEIPT WHEN VAUDATED. 440.6 24310800008 0000'1'1205 b00000000 4 Ds ;n cr+.'IF .- El? rr'��c.:rl'�iiL+ `a Rae.,Itag - tg go i $ -, >e ni =�. � IV Z, IP M E: Q ,A ..,! �x *arc K7 1 = C7 16 `I 0 ;.r -•7 NI 4,1 = CO al 11 ( 4-4- o •fit-. ni irt 2s? —..., ' rs ifs ra'C p n a. . r7$ Q it t, • I-+ � rt 7 ■ Rill 11" v- 1 i[/ Ib 0 Lea 0.1.0 4 12 NC "a Cy..... sw c"' r °J"7. 0. '• C n :n � rD �" P ri r.. , ,3 4, W c le rte. c `D 0. Qom. 9 G "s y rG x 1 r'-:..---.. Ss t7s 0 t'-'> c.-. V x 112.00 11.20 04/19/2011 10:50 8138069693 PERMITTING PAGE 05/07 04/19/2011 10:50 8138069693 PERMITTING POWER OF ATTORNEY To Whom It May Concern: 1, William. Alan Peacock, licensed qualifier do hereby give my permission to Jennifer A. Lopez, and Tabitha M. Vandemheen of Alarm Team to sign, submit & pick up peer wits on my behalf for Safe Streets USA, LLC until further notice. If you have any questions, please feel free to call. Thank You, William Alan Peacock License # EG13000404 State of ,"vC County of A ,e. day of 1'�,ere� . 20/1 ', by w o is personally known or presented the following identification Notary Public Signature Notary Public Stamp PAGE 06/07 04/19/2011 10:50 8138069693 PERMITTING PAGE 07/07 ACO U® PRODUOER CERTIFICATE OF LIABILITY INSURANCE John T. Costa Agency, Inc. 2025 Hamburg TPKE Suite J Wayne, NJ 07470 www.burgIaralarminsurance.com 'NOD SAFE STREETS USA,LLC 475 MARKET STREET ELMWOOD PARK NJ 07407 COVERAGE$ DAISRIMIDDIYYYY) 4/14/2011 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 POUCIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURER& SCOTTSDALE INSURANCE INSURER a: THE HARTFORD INSURER C: INSURER D: INSURER E: THE ANY MAY POUCIES. R POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING NG REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R A rnte ea nuata ur c Pu OLICY NU t AP SMMMI n emth POLICY N u umns GENIAL UAAIIJTY COMMEROWL GENERAL LIABILITY CPS1374192 4/17/2011 4/17/2012 EACH OCCURRENCE $ 1,000,000 $ 100,0OC DAMAGE-to RENTED PIvigslEe ooaw rajwet 1 CLAIMS MADE 151 ODOUR MED EXP (Any alo pascal) $ 5,000 PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGO $ 1,000,000 $ . 3,000,000 $ 3.000.000 GEM. 7 AGGREGATE UNIT APPUES PER: AOUCY I71 1 JECr 17 LOG B AUTOMOBILE — __Z. LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS 13UECUK0109 . 4/17/2011 4/17/2012 RI EDS INGLEUMrr $ 1,000,000 BODILY INJURY (Per Demon) $ BODILY (Perracci a t))RY $ PROPERTY DAMAGE (Permetlaent) $ GARAGELIABLLITY ANY AUTO AUTO ONLY -EA ACCIDENT $ • OTHER THAN • EA ACC 5 AUTO ONLY: APO $ A • EXCESS/ UMBRELLA LUA6IU Y OCCUR E CLAIMS MADE US$0001039 4/17/2011 4/17/2012 EACNOCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 — 1 DEDUCTIBLE RETENTION 510,000 $ $ $ g WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 13WECJL0911 4/17/2011 4/17/2012 1 TWR AMTB ro $ 1.900 000 EL. EACH ACCDENT rICEN MIN ER EXCLUDED? • cLuDE �(y� ld�� Lind SPECIAL OYISIrNS below E.L. DISEASE -CA EMPLOYEE $ 1.000.000 $ 1,000,000 EL strAsR- POLICY war A OTHER ERROR & OMISSIONS COS1374192 4/17/2011 4/17/2012 • $1,000,000 EACH CLAIM $3,000,000 AGGREGATE DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Project Ref: QERTIFI•ATF Lint nco Miami Shores Village 10050 Ne 2 Avenue Miami Shores FL 33138 LLATION SHOULD ANYOFTHEABOVEDESCRIBED POLICIES laR OANOELLED 9SFORe THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS y NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,13UT FAILURETO DO SO SHALL. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INStrara, ITS AGENTS OR REPRPSENTATNES. •• 10 Days for Nmt•Paymont oTPtYnJWA. AUTHORIZED REPRESENTATIVE Ralph A. Costa ACORD 25 (2009/01) CBRT NO.; 9$77404 CLRgy�` CCOBt EVEiE -1 Deborah Agp1e 6/14/2011 12&09&35 PH Page 1 00 Thio certilicat0 eaaceio 008 wpazcodoo 715, pre�rl.ott0iy xeeae8 C9y'tf.lSea e . 2 eC2e7v,(5--- a 1988 -2009 ACORD CORPORATION. All rights reserved.