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EL-12-1329Miami 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 ECM /ED JUL 17 U FBC 20 I O Permit No. eLa -132A Master Permit No. f G 11 -2W 5 7 Permit Type: Electrical JOB ADDRESS: 7 `I }.J C I 30 S- r,--.. -1- City: Miami Shores County: Miami Dade Zip : t Folio/Parcel#: ) 1 °- 3 a Q( D al 3 / 113 Q Is the Building Historically Designated: Yes NO Flood Zone: 4'licarcir-milf`tri OWNER: Name (Fee Simple Titleholder) 1 jj ZCL 2aA z!. Phone#: �1 /)E 130 .ST - -I- Address: 1 City: J1 't () inn `I ,S7-0).-es State: F/- Tenant/Lessee Name: /V A Email. AI A Zip: /.:,? Phone#: CONTRACTOR: Company. Name: Address: f 31 V .t�l. �� P T; ,� -� , ,.; "1 .,4 Phone#: 3 -_ R 0 ?A—An City: "1 s , State: FT__. Zip: . g.3J Qualifier Name: Phone#: State Certification or Registration #: Certificate of Competency #: Contact Phone#: DESIGNER: Architect/Engineer: Phone #: Email Address: Value of Work for this Permit: $ 2 f 7 s1:31 . C d Square/Linear Footage of Work: Type of Work: OAddress DAlteration I New ,Repair eplace ODemolition Description of Work: , t, +FL (L 1. A f\. (I L.A Sz.i. -t wt k_ . �'� f' q • 12 _ * ***,x******* ***** * ***** ******* ** ** * * **F ***** ** * ***** *** * * * * * ** *wax *** * **** ** **** * ** Submittal Fee $ Permit Fee $ /® t ) ePe, CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ _ Structural Review $ TOTAL FEE NOW DUE $ d s 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 'r 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 F.! .FCTRIC ; 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 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 a 4eeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochuke 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. Owner or Agent The foregoing instrument was acknowledged before me this 1 1-- day of �J , 20 \?,by who is personally known to me or who has produced �LI Do et 1 t� As identification and who did take an oath. NOTARY PUBLIC: Sign: Print My Commission Expires: *******9@*kA. A. k******'**A iAbdam* APPROVED BY The ent was owledged before me this irF day of , 20 {7-; by , who is personally known to me 'or who has produced - t 1J ICILS as identification and who did take an oath. NOTARY PUBLIC: //'4414.1 Plans Examiner Structural Review (Revised 3 /12/2012XRevised 07 /10/07XRevised 06/10/2009XRevised 3/15/09) Zoning Clerk Jul 26 2012 3:16PM DELTA RLRRM SYSTEMS ��wr� ter � :•Y. L Y• frog mow— Yw 7_ 1woo. 305 661 8133 W�Wti1— ��L1M1� — FOSO-CLASS US. POSTAON PAID FL PCRt1UT 110.231; 368806,-;7 •#9 NO1 A B LL -DO NOTPAY . au memo N /I.+acAnON RENEWAL DELTA ALARM SYSTEMS INC • TNQ, 385280- • 33186 UNIN3DAD3 COUNTY OWNER soc DELTA � k ALARM wm. SYSTEMS INC gliAggymv SYSTEMS NUNITORIa8 MINT TN! VICIATI f YAZ 07/11/2012 ;,a;..c;:,� .:,• 09010271001A 000250.00 :: DO omen ;. 101 DO NOT FORWARD DELTA ALARM SYSTEMS INC .JOSE 0 SW 131 O ST 101 MIAMI EL 33186 4. • • SST -CLASS U.B. PQ5rAOE PAID MUM, ft PERM I' NO. 231 THS aSNOT ASL - DO NT A0410126 RENEWAL • BUENOS NAM t 1.OLAnOEI mmismrmm 041012-6 •DELTA ALARM SYSTEMS INC . cc * 97E000177. 33180 SW 131 ST '101 6 UN1NADE COUNTY. OWNER • DELTA ALARM SYSTEMS INC 84WIVEMECTRICAL CONTRACTOR . " ra vaol rr r HOLGE�e �71py p�� ;nra �Qi1u�AA�.. trarrilweux 830101A11:,,; 000075.00 WOREERR /S DD NOT.POFIWA$u2 •DELTA ALARM SYSTEMS INC 1335U ST ORN 101 • MIAMI FL 33186 ' • p.1 Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENCY 97E000177 DELTA ALARM SYSTEMS INC D.B.A.: UINTERO JOSE Is certified under the provisions of Chapter 10 of Miami -Dade County MIAMI -DADE COUNTY TAX COLLECTOR 140 W. FLAGLER ST. 1st FLOOR MIAMI, FL 33130 041012 -6 BUBI NA FARM S S'BTEMS INC 13350 SW 131 ST 33186 UNIN DADE COUNTY 2011 ,LOCAL BUSINESS TAX RECEIPT 2012 MIAMI -DADE COUNTY - STATE OF FLORIDA EXPIRES SEPT. 30, 2012 MUST BE DISPLAYED AT PLACE OF BUSINESS PURSUANT TO COUNTY CODE CHAPTER 8A - ART. 9 & 10 , THIS IS NOT A BILL — DO NOT PAY RENEWAL ' CC #RECffig8b177 041012-6 DELTA ALARM SYSTEMS Sel MM. .ECTRICAL THIS IS ONLY A LOCAL . BUSINESS TAX RECEIPT. R DOES NOT PERMIT THE HOLDER TO VIOLATE ANY EXISTING REGULATORY OR ZONING LAWS OF THE COUNTY OR CITIES. NOR DOES IT EXEMPT THE HOLDER FROM ANY OTHER PERMIT OR LICENSE REQUIRED BY LAW. THIS IS NOT A CERTIFICATION OF THE HOLDER'S QUALIFICA- 'HONS. •PAYMENT RECEIVED MIAMU -DADE COUNTY TAX COLL.ECT19 /30/2011 02290062001 000075.00 ! SEE OTHER SIDE INC CONTRACTOR FIRST -CLASS U.S. POSTAGE PAID MIAMI, FL PERMIT NO. 231 WORKER /S 10 DO NOT FORWARD DELTA ALARM SYSTEMS INC JOSE QUINTERO MGRM 13350 SW 131 ST 101 MIAMI FL 33186 I11Lh11lLL11f111,h, f1L11h 1111I1I11h 111t11h11n1P 77th ACORD is CERTIFICATE OF LIABILITY INSURANCE UOBB 1/4.........-- 11-14-/D2011 THIS CERTIFICATEIS 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 ADDITIONALINSURED,the policy(ies) must be endorsed. If SUBROGATIONIS 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 PAYCHEX INSURANCE AGENCY INC 210705 P:()- F: (888)443 -6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: PHONE Extl: IA C, No): ( 8 8 8) 443-6112 E -MAIL PRODUCER CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC 0 INSURED INSURER A : Twin City Fire Ins Co INSURER B : INSURER C : EACH OCCURRENCE INSURER D : DAMAGE TO RENTED PREMISES (Ea occurrence) INSURER E : INSURER F : CLAIMS -MADE COVERAGES CERTIFICATE NUMBER: 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/OD/YYYY) POLICY EXP (MM/DD/YYYY) UM/TS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) 8 CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE 8 GEfQ'POLICY E�GATE PRO - I AP II S LOC PRODUCTS - COMP/OP AGG $ 8 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) 8 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ 9 UMBRELLA LAB EXCESS LIAB _ OCCUR CLAIMS -MADE 11/12 /2012 EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ —kJ TORY LIMITS 8 OT ER A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE MandaoryInNHREXCLUDED? If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N/A 76 WEG LS9445 11/12/2011 E.L. EACH ACCIDENT $100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 707, Additional Remarks Schedule, H more space Is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION City of Miami Shores Building Department 10050 NE 2 Ave Miami Shores FL 33138 le 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 7 _ -7 • ACORD 25 (2009/09) 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A R» - CERTIFICATE OF LIABILITY INSURANCE L../ DATE(MMIDD/YYYY) 7/17/2012 HOLDER. THIS BY THE POLICIES AUTHORIZED THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), 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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER John T. Costa Agency, Inc. 2025 Hamburg TPKE Suite J Wayne, NJ OT470 www.burglaralarminsurance.com CONTACT NAME: PHONE (A/C. No. Ext): 973-835-8444 FAX INC. No): 973- 835 -3056 E-MAIL ADDRESS: info@burgiaralarminsurance.com INSURERS) AFFORDING COVERAGE NAIC # INSURER A: Scottsdale Insurance UABIUTY COMMERCIAL GENERAL LIABILITY INSURED Delta Alarm Svstems,Inc 13350 South West 131st Street, Suite 101 Miami FL 33186 INSURER B : 4007757 INSURER C : 2/24/2013 INSURERD: $ 1,000,000 INSURER E : $ 160,000 INSURER F : COVERAGES CERTIFICATE NUMBER: 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADDL INSR SUER WVD POUCY NUMBER POUCY EFF (MDD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL 1 UABIUTY COMMERCIAL GENERAL LIABILITY 4007757 2/24 /2012 2/24/2013 EACH OCCURRENCE $ 1,000,000 q PREM ISESYEaEoNcurroence) $ 160,000 CLAIMS -MADE I OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP /OP AGG $ 3,000,000 GE 'L AGGREGATE POLICY i LIMIT APPLIES PECOT- PER: LOC $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED HIRED AUTOS SCHEDULED AUTOSWNED COMBINED eBIINED SINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (eaccMent)AMAGE P ) r $ $ $ UMBRELLA UAB EXCESS L.IAB 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 Y 1 N N / A WC STATU- TORY LIMITS R- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ J E.L. DISEASE - POLICY LIMIT $ A Errors & Omissions 4007757 2/24/2012 2/24/2013 $1,000,000 Each Claim $3,000,000 Aggregate DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, N more space Is required) CERTIFICATE HOLDER CANCELLATION City of Miami Shores 10050 Northeast 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 e:;22744gr--- Ralph A. Costa © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD CERT NO.: 13628788 Delta Alarm Systems,Inc 7/17/2012 8 :51 :04 AM Page 1 0£ 1 This certificate cancels and supersedes ALL previously issued certi£icatea.