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EL-11-1686Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 165925 Scheduled Inspection Date: October 27, 2011 Inspector: Devaney, Michael Owner: BERGER, BARBARA Permit Number: EL -9 -11 -1686 Job Address: 10580 NE 2 Place Miami Shores, FL Project: <NONE> Contractor: SAFE STREETS USA Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number Parcel Number 1122310130560 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 2>z„ October 26, 2011 For Inspections please call: (305)762 -4949 Page 23 of 24 01\151(1 -145`( Miami Shores Village Building Department /0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATION FBC 2004 SEP 1 2011 �U Permit No.E J I 1(D& Q Master Permit No. Permit Type: Electrical Owner's Name (Fee Simple Titleholder) afttfa Phone # - )6 I may�;j ' =Li Owner's Address 105%b N E a of City ( `1(161 S OiCS State FL Zip 3311S Tenant/Lessee Name E -MAIL: Phone # Job Address (where the work is being done) 1 LYS OC) N E City Miami Shores Village County Miami -Dade Zip 3S 1')J Z FOLIO / PARCEL # 1 I - aa3 I • o1°3 . 65to C) Is Building Historically Designated YES NO Contractor's Company Name 50Q. S l e rfs U t9 Phone # s313 'X& `1-2 g6 Ci-1 Con or's Address ) 1I 5 Ll . 1 C City_ State L Zip 3Smot � � � Phone # 1' x ' G `�KZ p Qualifier Name V l 1 ) I (L Y' State Certificate or Registration No. -7 ISryiy_hocp Certificate of Competency No. E -MAIL: Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ �'(Q - CY) Type of Work: DAddition ❑Alteration Describe Work: Square / Linear Footage Of Work: ❑ Repair/Replace ❑ Demolition V Submittal Fee $ Permit Fee $ /:5 ei, ' t- 47 CCF $ CO /CC Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Zoning $ Bond $ Code Enforcement $ Double Fee $ `� Structural Review. $ Total Fee Now Due $ See Reverse side -i 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 A}HDAVIT: 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 such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature L. Owner it Agent The foregoing instrument was acknowledged before me this day of ,20(i ,by who is personally known to me or who has produced As identificatio JVM tleiso.fa NOTARY PUBLIC: NOTARY PUBLIC h_ STATE OF FLORIDA Sign: i ='� ' Print ti'!,ll MINIM �1�� ' • Contractor //�� The foregoing instrument was acknowledged before me this"1 day of 20U , by who is personally known to me or who has produced �-[,... as identification and who did take an oath. NOTARY PUBLIC: . NOTARY UBLtC STA E Sign: Print: My Commission Expires: (01/11 � My Commission Expires: a/o' IL„I APPLICATION APPROVED BY: (Revised 02/08/06) Plans Examiner Engineer Zoning *warp, ....mho •." as4var s- sum shoms.tiRdjui Ankmussa.wem. ELECTRICAL CONTRACTORS LICENSING BOARD TAL SSSEEEMO OE ST • FLT 32399 -0783 PEACOCK1 WILLIAM ALAN 53 STREETS YN OAD SUITE 100 GARNER NC 27529 Con - : (ions! With this license you become one of the nearly one million . I : : ncensed by the Department of Business and Professional Regulation. Our professionals and Finesses range from architects to yadd 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 batter. For information about our services, please iog onto r r.m�oridafcense aom. • There you can find more Information about our divisions and the. regulations that impact part yyoou, s subscribe tto, department newsletters and team more about the Our mission at the Department is: License Efficiently, Regulate Fairly. We constantly strive to serve you bider so that you can serve your customers. Thank yowler doing business In Florida. and congmtutatlone on your new license! • DETACH HERE (850) 487 -1395 • StATEOPPLORIDA Ai# S$2' 621 DEPAR EENT OF BUSINESS AND- PROFESSIONAL RB0OLATiON • 8013000404 03/21/1,'.100310716 CERT ALARM SYSTER CONTRACTOR II PIACOM, WILLIAM ALAN OM STRUTS NSA LLC I$ 011711T$D sade;ttaprovisioas o! 0.489 11 • besatim a.e.e 110 31, 3011 I.110$3100e31 Ac# 552 $ $ STATE OF FLORIDA DEPART>!�NTffCALS ONTxAMEIRLTCENS]NO BOARD TiON E SE Q#141032200831 DATE BATCH NUMBER 10031071,6 • LI EG13000404 The ALARM SYSTEM CONTRACTOR II Named below IS CERTIFIED Under the provisions of Chapter 489 FS. • Expiration dates AUG 31, 2012 PEACOCK WILLIAM ALAN SAFE STREETS 'GSA LLC 5a 3 O g YNOR ROAD SUITE 100 RICK SCOTT GOVERNOR DISPLAY AS REQUIRED BY LAW CHARLIE LIEN SECRETARY ACO EP CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 4/14/2011 PRODUCER John T. Costa Agency, Inc. 2025 Hamburg TPKE Suite J Wayne, NJ 07470 www.burglaralarminsurance.com INSURED 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 NAIC # SAFE STREETS USA,LLC 475 MARKET STREET ELMWOOD PARK NJ 07407 1 INSURER k SCOTTSDALE INSURANCE INSURER B: THE HARTFORD INSURER C: INSURER D: INSURER E: COVERAGES 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. INSR LTR ADD'L NSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMMIDDIYYYYI POLICY EXPIRATION DATE IMMIDDIYYYYI LIMITS A GENERAL ✓ UABILITY COMMERCIAL GENERAL LIABILITY CPS1374192 4/17/2011 4/17/2012 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 CLAIMS MADE ✓ OCCUR MED EXP (My one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGO $ 3,000,000 7 POLICY 17 I T -r LOC B AUTOMOBILE u aiuTY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 13UECUK0109 4/17/2011 4/17/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 I BODILY INJURY (Per person) I BODILY INJURY (Per acddent) ✓ PROPERTY DAMAGE (Per acddent) GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ AUTO ONLY: AGO $ A EXCESS / UMBRELLA LIABILITY UBS0001039 4/17/2011 4/17/2012 EACH OCCURRENCE $ 5,000,000 ✓ OCCUR CLAIMS MADE AGGREGATE $ 5,000,000 DEDUCTIBLE RETENTION $10,000 $ $ ✓ $ B WORICERS AND EMPLOYERS' ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER (Mandatory If describe SPECIAL COMPENSATION LU181LITY Y/ N 13WECJL0911 4/17/2011 4/17/2012 WCSTATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1.000.000 EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1,000,000 In NH) under PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 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 I SPECIAL PROVISIONS Project Ref: CERTIFICATE HOLDER CANCELLATION Miami Shores Village 10050 Ne 2 Avenue Miami Shores FL 33138 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 80 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES..' 10 Days for Non - Payment of Premium. AUTHORED REPRESENTATIVE Ralph A. Costa eC:247‘e05-- ACORD 25 (2009/01) CERT NO.: 9977404 CLIENT CODE: EVERS -1 Deborah Apple 4/14/2011 12:09:35 PM Page 1 of 2 This certificate cancels and supercedes ALL previously issued certificates. © 1988-2009 ACORD CORPORATION. All rights reserved. 2011 -2012 HILLSBOROUGH COUNTY BUSINESS TAX RECEIPT EXPIRES 9 -30 -2012 FOL10 NO. STAMPS r FACIUTIES OR MAt FINES was Q J BEATS EMPLOYEES 1 16 BUSINESS LOCATION NAME MAILING ADDRESS OCC. CODE BUSINESS TYPE 280.000 PUBLIC SE VICE - LARMSYSTFVIS 16105 N FLORIDA AVE F LUTZ 33549 SAFE STREETS USA LLC 5305 RAYNOR ROAD STE 100 GARNER NC 27529 • 2012 BUSINESS TAX RECEIPT DOUG BEEN, TAX COLLECTOR HAS HEREBY PAIL! A PRIVILEGE TAX TO ENGAGE W BUSINESS. PROFESSION. OR OCCUPATION SPECIFIED HEREON. 813- 635 -5200 THIS BECOMES A TAX RECEIPT WHEN VALIDATED. RENEWAL 243108.0000 H. WASTE TAX SURCHARGE PAID - 3512 - 85 07/12/2011 *** 112.00 112.00