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EL-11-2177Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 170289 Scheduled Inspection Date: March 08, 2012 Inspector: Devaney, Michael Owner: GOLDBERG, JONATHAN Job Address: 9901 NE 13 Avenue Miami Shores, FL Permit Number: EL -11 -11 -2177 Project: <NONE> Contractor: VISUAL ACUSTICS LLC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alteration Phone Number Parcel Number 1132050090480 Phone: (786)390 -6128 Building Department Comments PREWIRE FOR LOW VOLTAGE SYSTEMS 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- 170216. Progress. /Y1-7z- srL March 07, 2012 For Inspections please call: (305)762 -4949 Page 13 of 33 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 No. Master Permit No. �� `I I — I (93 Li RECEIVED NOV711 1 BY._ Permit Type: Electrical ] , OWNER: Name (Fee Simple Titleholder): /n& haih 6o Id ber3 Phone #: 3�c -Cbs--' Address: 1 ` I 0 ( K G 1 /� 1P &\ (,L �J City: I r 1 i \a, '1 i Ores State: F I OY 4 GC. Tenant/Lessee Name: Phone #: Email: Zip: `33) g JOB ADDRESS: 1 D 1 13 Avalar, City: Miami Shores County: Miami Dade Zip: '32 j '3 g Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: V t S V at „ CPCIdiC. tie . Phone #: ; 206 -6' ‘7,-,q160 ' Address: 9 City: r( 0"' "' 11 State: F L Zip: 3 31 ')/ Qualifier Name: mare. (1&,)1 e. Phone #: / glpr' --`3 i Or %) L State Certification or Registration #: ET-11000-751- Certificate of Competency ##:-I�0 5G i� (3f 105 Contact Phone#: - Ta O '3� O -tQ 12S Email Address: Y' 0 O S Oa] v1C O US CS, n6. DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ 1 Q O _ Square/Linear Footage of Work: Type of Work: °Address Alteration New ❑Repair/Replace Description of Work: ys'c low -r( -'15 �1J °Demolition ** *** * ******** ******************** Fees * ***** ***************** ** ******** *** ** ****** Submittal Fee $ Permit Fee $ g $'69 e ®a 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 inspecti!: which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will note.. ,ed and a reinspection fee will be charged. Signature A, s wner or Agent The foregoing instrument was acknow day of who edged before me this ' -A. r who has produced As identification and who did take an oath. NOTARY PUBLIC: Signature Contractor The foregoing Q going instrument was acknowledged before me this PM day of I In kyr , 20 , by � ' 1! ► , who is personally known to me or h proaui eu identification and who did take an oath. NOTARY P IC: APPROVED B **** ****** ***** ***** ***********+ u*****+ x*+ x+ x+ u*+ r****: x***** **+ x************* ** ************* 2 kst-Ze 0"--/7 Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) Zoning Clerk 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: BUILDING ROOFING Permit No. Master Permit No. OWNER: Name (Fee Simple Titleholder): Phone#: Address: City: State: Zip: Tenant/Lessee Name: Phone #: Email: JOB ADDRESS: City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Ls the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: Phone#: Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: Type of Work: OAddition OAlteration ONew ORepair/Replace ODemolition Description of Work: **** ****** ****** ***+x **** **** *********** Fees* **+ x+ x****************+x*****x:+x+x *+x*+ +x*+x******* Submittal Fee $ Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ VISUA -2 OP ID: NR '41' -1C11W CERTIFICATE OF LIABILITY INSURANCE DATE (MNUDDNYTY) 11/17/11 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(ies) 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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 305- 262 -0086 BUTLER, BUCKLEY, DEETS INC. 6161 BLUE LAGOON DR., STE 420 MIAMI, FL 33126 CONTACT BRANDON BUTLER AICNN , 0) :786- 216 -1782 FAX , No): 305- 262 -0187 i.MpIL ADDRESS: BBUTLER @BBDINS.COM INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Allied Property & Casualty Ins 42579 INSURED VISUAL ACOUSTICS LLC ROMA HOLDINGS CORP 2227 BISCAYNE BLVD MIAMI, FL 33137 INSURER B:Allied Property & Casualty Ins 42579 INSURER C: 11/18/12 INSURERD: $ 1,000,000 INSURER E : 10O $ 100,000 , INSURER F : RTIFICATE 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POUCY NUMBER (MMO/UDDY/YYYY) (MM POUCY UMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY ACP GL 5904783058 11/18/11 11/18/12 EACH OCCURRENCE $ 1,000,000 DAMAGE T PREMISES (O Ea RENTED occurrence) 10O $ 100,000 , CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENII AGGREGATE 7 POLICY LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ B AUTOMOBILE X X UABIUTY ANY AUTO ALL OWNED AUTOS HIRED AUTOS — X SCHEDULED AUTOS NON -0WNED AUTOS ACP BAP 5904783058 11/18/11 11/18/12 COMBINED SINGLE LIMIT ( 300,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per sodden() $ $ UMBRELLA LIAR EXCESS UAB _ OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN N / A WC STATU- TORY LIMITS OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY OMIT $ B Property Section Commercial Appli ACP5904783058 11/18/11 11/18/12 ELECTRICAL WORK -WITHIN BUILDINGS/ *30 DAYS NOTICE OF CANCELLATION EXPCEPT�uI�) FOR NON PAYMENT OF PREMIUM 10 DAYS NOTICE. Iadlei CITY OF MIAMI SHORES 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 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 ACORD aM' ° t r 7 in. _ a l r �ATE(MM/DD/YY) ' _ TM_ .11/17/11 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 pollcy(ies) 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 this certificate does not confer rights to the certificate holder in Iieu of such endorsement(s). PRODUCER PAYCHEX INSURANCE AGENCY, INC. 150 SAWGRASS DRIVE ROCHESTER, NY 14620 COMPANIES AFFORDING COVERAGE COMPANY A AMTRUST OF NORTH AMERICA/TECH COMPANY B INSURED VISUAL ACOUSTICS LLC 2227 BISCAYNE BLVD MIAMI, FL 33137 CO C ANY COMPANY u �.. ;`°u..n tea,. 'aY m► a�y� it ,c, . M t { 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE (MMIDD/YY) POUCY EXPIRATION DATE (MMIDDIYY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ I COMMERCIAL GENERAL LIABILITY PRODUCTS- COMP /OPAGG $ In—CLAIMS MADE I -OCCUR PERSONAL & ADV INJURY $ OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE $ FIRE DAMAGE (Any one lire) $ MED EXP (Any one person) COMBINED SINGLE LIMIT $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ 1 UMBRELLA FORM 1 OTHER THAN UMBRELLA FORM AGGREGATE $ $ A WORKER'S COMPENSATION AND EMPLOYERS' LIABIUTY TWC3295904 12/07/11 12/07/12 X WC STATU- OTH- • • „IB EL EACH ACCIDENT $ 100,000.00 THE PROPRIETOR/ PARTNER3/EXECUTNE OFFICERS ARE. X INCL EXCL EL DISEASE - POLICY LIMIT - EL DISEASE - EA EMPLOYEE $ 500,000.00 $ 100,000.00 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) '' "'. CITY OF MIAMI SHORES 10050 NE 2ND AVENUE MIAMI SHORES, FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ..,. 583876 -9 auVISUAL A U TICS LL 2227 BISCAYNE BLVD 33137 MIAMI T PAY Omen VISUAL ACOUSTICS LLC Sec. Type of Business 196 SPEC ELECTRICAL is IS ONLY A LOCAL $08:SS TAX t4ECE Pr, !T es NOT PERMfl THE LNER TO VIOLATE ANY isms riesutxrcav ON MO NANY OE. NOE GS IT EXEMPT THE TATES PEON ANY OTHER CIO I' A C Ti5CA1105 L.n5 S TAX AtAOTOW 07/06 /2011 09010216001 000045.00 SEE OTHER SIDE TO DO NOT FORWARD VISUAL ACOUSTICS LLC MARC LEWIN PRES 2227 BISCAYNE BLVD MIAMI FL 33137 Ihi Still llll 111111 t1 H 1 1 1 1 11 Lie it itlill RANTI 18105 -5 sUsiNeSs IstAmE d LOCA VISUAL ACOUSTICS LLC 2227 BISCAYNE BLVD _137` MIAMI SUAL ACOUSTIC TYPeief _ leteree tN 1y4 A L.0CAF_ TAX AECET IT LES NOT PerMtr Tile AV ONO LASS OP THE SALTY Ott Oat0S. NON rr /O NW ON LICENSE 8Y 4AW. THIS tS HOLDER'S ATm of . DO NOT FORWARD VISUAL ACOUSTICS LLC MAR LEVIN PRES 2227 BISCAYNE BLVD MIAMI FL 33137 • 045.00 i lil 1It7Jlflt/Jlriiie 11IitJIJ Iltirftthh tltfl$ iabaft.' SEE OTHER SIDE VISUAL AC0 S MARC ` LEWIN PRES 2227`BISCAVNE BLVD MIAMI FL 33137 Q��Ytht� rrbr: VO