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EL-11-1805Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 165734 Permit Number: EL -10 -11 -1805 Scheduled Inspection Date: October 24, 2011 Inspector: Devaney, Michael Owner: BERNARD, BJOERN Job Address: 1179 NE 98 Street Miami Shores, FL Project: <NONE> Contractor: ADT SECURITY SERVICES, INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number Parcel Number 1132050180290 Phone: (786)331 -3967 Building Department Comments BURGLAR ALARM Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments /2_ S)-c/•?,/ October 21, 2011 For Inspections please call: (305)762 -4949 Page 20 of 22 1010512011 01:57 9544287079 4,�t. ADT SECURITY SERVICE PAGE 1102 ACCAR CERTIFICATE OF LIABILITY INSURANCE CA g;; arecrvi THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIImTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE. AFFORDED BY THE POLICIES BELOW. HIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER. IMPORTANT: If the cartEief holder Is an ADDITIONAL INSURED. the polsy(les) crust be endorsed. If SUBROGATION IS WAIVED. subject to the term and cactiNc a 01 the policy. certain policies may require an endorsement, A statement on this certifi+a$ does not corder rights to the certificate holder In lieu of Bush endarseme s Pi4OC nCER Marsh USA Inc. 1186 Avenue of to Americas Now York, NY 10036 TA NAME Mae lbef: (2'7,2) 34,$ -5000 AQORESS. rtici, No1r tNSURER(S) AFFORDING COVERAGE mist/RED ADT Security Services Inc DBA Sensormatic 1501 Yamato Road Buss Raton, 33431 United States NAIC tt INSURER A: AGCS Marine Insurance Company (AANanz) INSURER B: CHARMS CASUALTY COMPANY INSURER C: Commerce & Industry ins Co. INSURER D: Ilfi,ols National Insurance Co. INSURER E: Nat'l Union Fne his Co. of Pittsburgh, PA INSURER F: New Hampshire Ins_ Co. . 22837 40258 19410 • 23817 19445 23841 COVERA RTIFICATE NUMBER. 875189 - REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTER BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTMTHSTANDING ANY REQUIREMENT, TERM Ott CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICA'T'E MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONpf(IONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OFW$URA J E A POI NUMBER 1 � �� mi ' utan$ F GVNERAL UAetlnv GL 240607 (Prim8ry GL) 1011)2011 10/1/2012 EACH OCCURRENCE $ $1,000,000.00 X COMMERCIAL GENERAL, 'ABILITY bAE Ar�E 7O REt4TEfl ��ES? oC!w) MED EXP (Any ono perrnorn $ $1,000.000.00 I CLAIMC DE IX j OCCUR 1 $ $10,000.00 CON1 ACraia$ /ROT PERSONAL a AOv Iwjgy s $1,000,000.00 H0WNS& GENERAL AGGREGATE $ $2,000,000.00 OEM AGGREGATE LIMIT APPLt6$ F'ER: POLICY 1111 e t) L•i PRODUCTS - COMP/OP AGO $ $2,000.000.00 $ E E F AUiCIMKIFIR.E UA88 IT1f Ell ANY MJTO OA 3505468 NA) CA 35064655 (MA) CA3506464 (AO$) CA 3,50$4$$ (NH) (Primary AL) 10/1/2011 10/1/2011 10/12011 10/12011 10/12012 10/1/2012 10/12012 10/1/2012 • • Yi iVhU INta1E LIMIT (es aeeiderrt $ $1,000,000.00 BO8LY iNaURV (per mew) 8 _ JGM1 ALLt3VfMED AWV6 NtREDAUTpS X sCffEDULED NAGN�swNEO ALrIOS t3pbrlvnvnit2vtFbrac+ feniq (Per a PROPERTY itt( (Peratameny S NEW IiAMPSNIRE 8 50,00000 $ UWfR8U.A MB EXCESS LIAO OCCUR ihAlMg MADE EACH OCCURRENCE AGGREGATE PROW=- $ LIED R6TEN11. N 8 NEW HAMPSHIRE (CSL) $ B C D E F WO COMPENSA'n6N AND .ovEts imam YIN WC 015864008 (CT,GA,PA,SC) WC 015$94006 (FL) } WC 015884008 1) WC 015884004 (CA) WC 015894007 (MA ND, OH, WA • y O_ . OCR OCW 91128600 OC A OCW 91128600 OC & OCW 91128600 10/1!2011 10/1/2011 10/1/2011 10/12011 1x12011 10/12011 10/12011 10/12011 1x112012 10M/ 012 10/1/2012 10/12012 10/1/2012 10/1/2012 10112012 10/1/Z012 x veer TANS - I 10TH - . EL MACH ACCIDENT $ $2.000.000.00 ANY PR4PRIETORMARITIENEXMCUTIVE and yOEO? c+ In NH) oil" N IA EL DISEASE. EA tEuIPt Sy6E $ $2,000,000.00 Mym, aeon under 17C9CRtPT1ON p> pPOpattONS Wow EL, MASS - POLICY umn- a 82,000,000.00 tJSD $1.000,000,00 par jabaite USD $1.000,000,00 per,jowte USD $1,000,000.00 per conveyance A A A Bu8dees RLerctrrfailaffon/Contract Works Reiner Equipment /Contactor% Equipment Blanket Thn8$ _____ OESCH1r11014 OF GPEHAVONS 1LOCAmaNS r VUN1CLES (Attach ACORD 101, AfFsecnel Reirmits Sdh date, n mom some is mow) Please refer to attached ACORD 1.01 for further remarlt_+. _ CERTIFICATE HOLDER VILLAGE OF MIAMI SHORES 10050 NE 2N0 AVENUE MAIMI SHORES. FL 33138 United States CANCELLATION SHOULD ANY OF "DM ABOVE DESCRIBED POUC1FS t CANcE1J.EDBEFORE THE EXPIRATION DATE THEREOF, NOTICE HILL BE DELIVERED IN ACCORDANCE WITH THE POL.IGY PROVISIONS. ALITROREMEI REPRESENTATIVE MA/Mit tIM W0, ID/: ACORD 25 (2010105) Fm Mock claim' P8NOa R7n TterallIhutan 41988.2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registorad marks of ACORD } 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 B - Permit No. ei Master Permit No. .10-` Permit Type: ELECTRICAL Owner's Name (Fee Simple Titleholder) �/�one # Owner's ddress l% 19 `` ' 9J IM City to Zip Tenant/LesseeName Phone # Email Job Address (where the work is being done) // 9 9 % City Miami Shores Village County Miami -Dade Zip FOLIO / PARCEL # J/ 3.7-4157-0/7 ---e) 2)9e) Is Building Historically Designated YES NO Flood Zone Contractor's Company Name % ‘AfiieRhone # OS-17j2406 —1-7/1 Contractor's Address .2 FS /' City L / State Qualifier Name . 2/ e/4 State Certificate or Registration No. iee /4 Contact Phone &S-f) 57/ E -mail Architect/Engineer's Name (if applicable) Certificate of Competency No. Phone # Value of Work For this Permit $ /60 Square /Linear Footage Of Work: Type of Work: QAddition ❑Alteration :New ❑ Repair/Replace 0 Demolition Describe Work: (,#) ee/ Ct)/ - (2) .4)00, ******** * * *** * ** * * * * * * * * * * * *** * ***** * ** Fees * * * * * * * ** * * * ***** x, * *, *** * * * * * * * * ** *** * * * ** Submittal Fee $ Permit Fee $ /40/ 4" 4" CCF $ CO /CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ 5.15 ' See Reverse side --> Bonding Company's Name (if applicable) r j Bonding Company's Address City State Zip M i tgage Lender's Name (if applicable) Mortga - Lender's Address City State Zip Application is here made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to ► 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 approved and a re- inspection fee will be charged. Signature -al al' Owner or Agent Contractor The foregoing instrument was acknowledged before me this 44( The forego g ins' ment was acknowledged before me thi26 day of , 20 IA , by , day of ! Miami -Dade My Home My Home Show Me: 'Property Information Search By: ' Select Item jj Text only Property Appraiser Tax Estimator r; Property Appraiser Tax Comparison Portability S.O.H. Calculator Summary Details: Folio No.: 1100 SINGLE FAMILY RESIDENCE 11- 3205- 018 -0290 Property: Beds /Baths: 11 Mailing (BJOERN M BERNARD Address: AAdj Sq Footage: 2,035 Lot Size: 9,456.72 SQ FT 1179 NE 98 ST MIAMI 1948 Legal Description: SHORES FL 33138 -2571 Property Information: Primary Zone: 1100 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds /Baths: 3/2 Floors: 1 Living Units: 1 AAdj Sq Footage: 2,035 Lot Size: 9,456.72 SQ FT Year Built: 1948 Legal Description: REV PL MIAMI SHORES SEC 8 PB 43 -69 LOT 20 BLK 179 LOT SIZE IRREGULAR OR 19212- 1969 07 2000 1 COC 26278 -0630 03 2008 1 Assessment Information: Year: 2011 2010 Land Value: $137,131 $114,010 Building Value: $211,374 $212,565 Market Value: $348,505 $326,575 Assessed Value: $331,473 $326,575 Exemption Information: Year: 2011 2010 Homestead: $25,000 $25,000 2nd Homestead: YES YES Taxable Value Information: ear: 2011 1 2010 Applied Applied ITaxing Authorit Exemption/ Exemption/ Y T L I T L I ACTIVE TOC(L SELECT Page 1 of 2 4t C- Aerial Photography - 2009 My Home 1 Property Information 1 Property Taxes 1 My Neighborhood 1 Property Appraiser Home 1 Using_Our Site 1 Phone Directory 1 Privacy 1 Disclaimer 111 ft If you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at Webmaster. Web Site © 2002 Miami -Dade County. All rights reserved. http: / /gisims2. miamidade .gov /myhome /propmap.asp 9/29/2011 _'. L.* AL SAS i"AX CEIPT 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: ADT SECURITY SERVICES INC Owner Name: GEORGE MANGINELLI Business Location: 10785 MARKS WAY MIRAMAR Business Phone: 954- 325 -0200 Rooms Seats Receipt #:EL181- 227467 Business Type: ECTRICAL /ALARMS /CO (ALARM SYSTEM CONTRACT° Business Opened:o8 /28/2009 State/Cou my /Cert(Reg :EF 0 0 0 1121 Exemption Code:NC EMPT Employees. 30 Machines Professionals For Vending Business Only Number of Machines: Vending Type: Tax Amount Transfer Fee NSF Fee Penalty Prior Years Collection Cost Total Paid 81.00 0.00 0.00 0.00 0.00 . 0.00 81.00 THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT WHEN VALIDATED 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 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 i¢ in nmmnlianr•o with Ctato nr Inra1 lawv owl rantdatinne TOR I)