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EL-11-2184Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 171319 Permit Number: EL -11 -11 -2184 Scheduled Inspection Date: March 21, 2012 Inspector: Devaney, Michael Owner: KING, KEVIN Job Address: 390 NE 97 Street Miami Shores, FL 33138 -2046 Project: <NONE> Contractor: FLORIDA BURGLARY CONTROL INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number (305)962 -7105 Parcel Number 1132060135810 Phone: (305)965 -4064 Building Department Comments HOME SECURITY SYSTEM INSIDE THE HOME Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments , 1 7 5-4 //y77/-__ March 20, 2012 For Inspections please call: (305)762 -4949 Page 21 of 23 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 OWNER: Name (Fee Simple Titleholder): e(p Address: 3 `O 'V • 9 i 45-4 City:✓�,z..- ,7 � � �' State: TIT TV 20 Permit No. 'I1�I Master Permit No. Tenant/Lessee Name: fret Phone{ %,2-7/as zip: 33 /26 Phone#: Email: JOB ADDRESS: 33C) /bi City: Miami Shores County: Miami Dade zip: 3'3/ Folio/Parcel #: NO %C Is the Building Historically Designated: Yes Flood Zone: CONTRACTOR: Company Name: ?rb, ii 4 / ar Phone #: -74)' d. 3f 7�3 Address: ‘1L-70 ,Iv w e S ..'1 4 c Jo Li City: J'l U � ) State: -� Zip: : 3 Q 1 Pc 5' Qualifier Name: , A *A A IN f C� i Phone #: State Certification or Registration #: �'f o 0 $ 3 J Certificate of Competency #: _ l Contact Phone #: -).S- q 6 - ` ,0 Oj Email Address: C., .c f ,nay c ■-e % 1 a . lot i j C'° '°rte''° (. C o `0i1 DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 3 Gl • 0 Type of Work: ❑Address UAlteration Description of Work: \\o v- -e 5 €,C•_. »� Square/Linear Footage of Work: ,'New ORepair/Replace ODemolition s 1) ,Lh 0k 40,.A.-1-k *************** * ***+x+x******* ******* **** Fees ******** : *• x* *******+ x*+ x********************** Submittal Fee $ Permit Fee $ l® ' ' 2 CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ 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 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 x Owner or Agent ll / / Contractor The foregoing instrument was acknowl ged before me this ) o'- The foregoing instrument was acknowledged beforeehe this" day of l ew4ti2 (11 s , by � �.�1 1`o nc , day of �- U Q 7e,r' 20 J / , by �e 3Sk l A4 (-- who is personally known to me or who has produced % who is personally known to me or who has produced Signature l At (-it" " ) ( As identification and who did take an path. NOTARY PUBLIC: Sign: Print: My Commission Expires: CARMEN B. URQUIZA Notary Public, State of Florid Cnmmission #DD841027 My Commission Expires Nor. 24, 2012 as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: CARMEN B. URQUIZA/ Notary Public, State of norldit Commission #DD841027 Mt 0arm,irsh n (Wm Nut. 24, 2012 My Commission Expires: // APPROVED BY Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Clerk Nov v. 2 9 + 2 01,1J ... 15 AM, FROM: F2M/12886291362 No. 0178 P. 2 MSGSt 69358492 -0B0-1 POD 983 OP 983 '°,�'°f CERTIFICATE OF LIABILITY INSURANCE LTRD RO 01 DATE IMM/DD /YYYY) 11 -29 -2011 THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY ANb 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 ADDITIONALINSURED,the policy(ies) must be endorsed, if SUBROGATIONIS WAIVED, subject to the terms and conditions of the policy, oertein policies mey require en endorsement. A statement on this Certificate does not confer rights to the cart" e e holder i li= of such end. - _ ent s - PAYCHEX INSURANCE AGENCY INC 210705 P: ()- F: (888)443 -6112 PO SOX 33015 SAN ANTONIO TX 78265 8YSURQO FLORIDA BURGLARY CONTROL INC 17670 NW 78TH AVE STE 204 HIALEAH FL 33015 COVERAGES CERTIFICATE NUMBER( NUMBER: THIS IS TO CERTIFY THAT THE POLICIES Op INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED REVISION 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 HAW BEEN REDUCED EY PAID CLAIMS_ TYPE OF OVSNRAnlca "• rn -r GENERAL IJANI V POLICY NUA/dl�R Oy�y/O COMMERCIAL QENERAL LIABILITY J CLAIMB•MADE n OCCUR ACT PWONE tic, o. Gxslt RaDJ ER CUptamPR ID of A/C, No): (888)443 -6112 INSUR8R18) AFFORDING COVERAGE INSURER A: Twin City Fire Ina Ca NAIL/ INSURER 0 ; INSURER c INSURER o I INSURER C : INSURER F ; ft,. ADO LIMIT AI �9 PEA POLICYJRCT I�I LOC ADEXIADDIEN uAAILI r ANY AUTO ALL OWNED AUTOS SCW;DULED AUTOS HIRED AUTOS NON -OWNED AUTOS CIMESEILq LMD EXCESS MAAI DEDUCTIBLE ENTION 9 W s COMPENSATION ANDBMFLOYEiS' WOW/ ANY PROPRIETOpRMARTNER/EXECUTN A OFFICER /MEMBER EXCLUDED? StIsf lesiX Or AY/) DE98SRPT'ION under l+ P EBAnONS below Nou (MM/DD/TITT17 LAM 'EACH OCCURRENCE DAMAGE TO RUN rED PREMniege (E9 oEEunsnuel MED EXP (Any set Psraon1 PERSONAL & stw INJURY GENERAL A1RREGATE e PRODUCTS. COMP/OP ADD CCMfiIN!'P SINGLE LIMIT fE..cd48nt) e BODILY INJURY fear Imam) BODILY INJURY Pe .cciCent) PROPERTY DAMAGE (PST.E8tdel>t) e OCCUR MAIMS-MADE N/A '76 WEG LN3 B 12 06/23/3011 05/23/3012 OLSCR/ITIONOP GRaRArroas/ tOCA9'/ONs/ %em elt& /Amwb ACORD 1OV, Addkbna/ 11 nnalks &W ilk do K roar Doom* /a nquksd) The usual to the Insuredts Operations. CERTIFICATE HOLDER EACH OCCURRENCE 9 AQGREGATI 9 XI A &3LPMTVi1 I° "' EL. FACE{ ACCIDENT EL. DISEASE - EA EMPLOYEE EL. DISEASE • POLICY LIMIT . 100,000 . 100,000 . 500,000 MIAMI si3oREs VI2r,LAGE ATTN: ARLENE$ 10050 NE 2ND AVE MIAMI SHORES, FL 33138 ACORD 25 12009/09) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION bATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Aunent rsa AlPRFS&MATNC P 1988-2000 ACORD CORPORATION. ACORD name and logo ere registered marks of ACORD All rights reserved, Nov, 29. 20111 10:14AM Gil Garden Avetrani ACCIIRD No. 0174 P. 12/2 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 6/20/2011 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(les) 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 thls certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Oil, Garden„ Avetrani Insurance Group 10689 N. Rends11 Drive Suite 208 Miami FL 33176 INSURED Florida Burglary Control, Inc. 17675 NW 91st Court Miami COVERAGES FL 330i.8 COMNTAC EI T Mart & Sarrionu.vo �IA PH ((VCC.. No. Est)_ (305) 630 -4777 gS :nMartahItgg Rig . coot PRODUCER lD 0002012 INSURER[$) AFFORDING COVERAGE r .Not: (ao0 2'IP m9 NAIC • INSuRER A;Alterra Excess & Surplus Inc.00 INSUasa 6 : INSURER C ; INSURER D: INSURER g I INSURER r : CERTIFICATE NULiiuER:CL116201728 REVISION NUMBER: 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, INER EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS AUDL1SUBR LTR TYPE DP INSURANCE POLICY EFF POIJay PIP %MS Y,ND POLICY NUMBER 1MWDD/YYYYI tscwo /YYYY) GENERAL IJABIU1Y X COMMERCIAL GENERIAL LIABIUTr A CLAIMS -MADE X OCCUR X Slims & QZ2Imaxoas INCLUDED GERI AGGREGATE LIMIT APPLIES PER; 1 POLICY n , o. E 1-00 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS _ SCHEDULED AUTOS _ HIREDAI/TOS NON -OWNED AUTOS N=OI,0333000o1a 6/9/2131], 3/8/3012 EACH OCCURRENCE ►� +rl . -ra, a. LIMITS PREMISES (Et acQJrrenca) MHO E2cP (Any ens parson) s 1,000,000 $ 100.000 $ 5,000 1,000,000 2,000,000 2,000,000 PERSONAL R ADV INJURY GENERAL AGGREGATE FRODUCTS. COMP/OP AGG UMBRELLA LIAR EXCESS UAB OCCUR CIA MS.MADG DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYED uASILITY ANY PROORIETURADARTNERMICEc DFPIC5RIMBMSER EXCLUDED, (Mandatory In NI1) II pre, OE$0RIPfioN OF OPERATIONS below COMBINED BANGLE LIMIT (Es sccidanl BODILY INJURY (Per parson) BODILY INJURY (Per eeeident) PROPERTY DAMAGE (Par sadden° EACM OCGURRENCE AGGREGATE $ $ YIN NIA I T LIMr Q l 1 EETIri- $ EL. EACH ACCIDENT $ EL. DISEASE- EA EMPLOYEE $ DESCRIPTION OF OPERATIONS 1 LOCATIONS /VEHICLES (Attach ACORD 1M, Adational Remarks Schedule, it more space le requires CERTIFICATE HOLDER EL DISEASE. PODUY LIMIT 8 CANCELLATION VILLAGE OF NIA= SHORES 10050 NE 2ND AVE )MIA= SHORES, FL 33138 ACORD 25 (2008/08) INS025(so09e) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ExPIRATION DATE THEREOF, NOTICE WIU. BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTNORQED REPRESENTATIVE e Rodriguez/y, • The ACORD name and I © 1008-2009 ACORD CORPORATION. All rights reserved. ago are registered marks of ACORD `2U1�e. 'LC4OPOUS1NiSS, {. Ir�ltd fC r_ $.0t :3D14412L . 2.#14i7(iQ Ni&1 00;0414 '1ii i q �` • ,. .i -i.�- _ - a...t 4 • _ •s' --�f ��i.� ^P Y`. a 0 —41-6 THIS 1S NOT A BELL - DO NOT PAY 644595 -1 RENEiJAL FIRST-MASS U.S. POSTAGE PAID WWI, FL PERMIT ND, 231 "V MAJ �'R�Y CONTROL INC STATaingl 00831671433 -2 U 'R£' 17670 NW 78 AVE 204 33015 UNIN DADE COUNTY etRIDA BURGLARY CONTROL INC S®Ygga o5(RefECTRICAL CONTRACTOR i IS ONLY A LOCAL (NESS TAR RECEiir7.. �Ir S HOT PERMIT DER TO INMATE AM ;TING REGULATORY OR INC JAWS OF THE PITY OR CRIER. NDR S IT EXEMPT THE DES FROM ANY OTHER Illr OA LICENSE U INEO DY LAW. T&IW IS A CERTIFICATION OF HOLDER'S OUAI.IFTCA- .IENT RECEIVED II•DADE COUNTY TAX .ECTOR: 07/26/2011 60000000071 000075.00' WORKER /5 5 DO NOT FORWARD FLORIDA BURGLARY CONTROL INC LEONARD J FERNANDEZ 17670 NW 78 AVE 204 MIAMI FL 33015 iaJmAllIRRIIIu,i&Ardheb.IJi1.1I =I41R:iiiatt