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ELC-13-0440Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 186812 Permit Number: ELC- 3- 13440 Scheduled Inspection Date: September 30, 2013 Permit Type: Electrical - Commercial Inspector: Devaney, Michael Owner: INC, PUBLIX SUPERMARKETS, Job Address: 9050 BISCAYNE Boulevard Miami Shores, FL 33138- Project: <NONE> Contractor: TYCO INTEGRATED SECURITY comments RELOCATE FIRE ALARM DEVICES. ADD ONE STROBE AND INEW HOOD Passed Failed Correction a Needed Re- Inspection ❑ Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspection Type. Final Work Classification: Addition /Alteration Phone Number (863)688 -747_ Parcel Number 1132060100010 INSPECTOR COMMENTS False Inspector Comments Phone: (954)266 -5063 September 27, 2013 For Inspections please call: (305)762 -4949 Page 3 of 30 YjD\\��-jq%-k " MTD:1goy- or1 Ali � Shoves Villa g e Building Department 0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 7 SPECTION'S PHONE NUMBER: (305). 762.4949 BUILDING Permit No. PERMIT APPLICA ION Master Permit No.. FBC 20 Permit Type: ELECTRIC '': Owner's Name (Fee Simple Titleholder 9 Owner's Address 9 05n -b City\ tsyP \ ` (O CpS • State Tenant/Lessee Name Email Job Address (where the work is being City Miami Shores Village FOLIO / PARCEL # 0 t �)o Is Building Historically Designated Contractor's Company Name 1 V Contractor's Address City V\�\f `b�lr Qualifier Name 2 State Certificate or Registration No. Contact Phone 06\-1 - ea l)�A\k 'S 0 Ck2 fr Phone # I r-•y IL "7P I �,Y . si.......... 440 zip �J313 'i Phone # ne)9 050 ` \ \I.Ii�Q• \ \JC . \ l� 'E�``�iC County Mimi =Dade Zip eES NO Flood'Zone 1A- noorAeA Phone # q54 - �71 ( (L, • State I Phone # -5) • ec1 6 . Certificate of Competency No. i Sb(p- E -mail �DV '5� 6 V 1--(n _ Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: Addition aeration ❑Ne, ❑ Repair/Replace ❑ De r I Describe Work: ° Submittal Fee $ Per4t Fee _ CCF $O /CC $ Notary $ Traiping/Education Fee $ Techr Scanning $ Radon $ DPBR; $ Bond $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due ogy,Fee $ — �,-�� l See Reverse, side Bonding Company's Name (if Bonding Company's Address _ City 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 cert ified 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, e S Signature Owner or Agen C c The foregoing instrument was acknowledged before me this The fore oing instrument was acknowledged before me this day o , 20), by r�• C �i-� day of 201 who is onally to me or who has produced — who is personally known to me or who has roduced rwe6 r r Y P As identification and who did take an oath. I t VITL. as identification and who did take an oath. NOTARY PUBLIC: Print: JODI L SLOAN �wr rye,. ewe= i H t�nt�M MVMruttu My Commission Expires:,, S –1 MY COMMISSION # EE 056818 My Commission Exp My coMr�tsstoN EE 074432 + • EXPIRES: February 5, 2015 EXPIRES: March 16, 2015 w Q ry �Af;aQ° Bonded Thru Notary Public Undenvrlters f9%Foe etOP�� Bonded Thor S8Mb86 a.ee APPROVED (Revised 07 /10 /07)(Revised 06/10/2009) Rzf C . Plans Examiner Engineer Clerk checked - - . —I ?V — . -• w.rv.'q r a L7\Jti711tlLa4.7 P%^—R"EWkor-1 r'11 .• ..- 115 S. Andrews Ave., Rm. A -100, Ft. Lauderdale, FL 33301 -1895 -- 954 - 831 -4000 VALID OCTOBER 71 2012 THROUGH SEPTEMBER 3g, 2013 DsA:TYCO INTEGRATED SECURITY LLC Receipte.,INECT 53 AL /AI,ARMS/ Business Name: Business Type: (ALARM CONTPJ.CTOR) Owner Name: DAVID J ZACHRY Business Opened:02/08/1993 Business Location: 20765 MARKS WAY State /County /CerUReg =0000478 MIRAMAR Exemption Cade: Business Phone: 561 -988 -3600 Rooms Bests Employees Machines Profe"Ii nals 57 For ending BusinRSa only Nlumlf9r of Matrhinee. Tax Amount Transfer Fes NSF Fee penalty Prior Years Collection Cost Total Paid 150.00 15.00 0.00 0.0 0.00 0100 165.OQ THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF SUSINESS THIS BECOMES A TAX RECEIPT This tax Is levied for the privilege of doing business within Broward C ounty and Is non - regulatory in nature.. You most meet all County and/or Municipi lily planning WHEN VALIDATED and zoning requirernerrs. This Business Tax Receipt must be transferred when the business is sold, )usiness narne has changed or you have moved the business location, This •ecelpt does not Indicate that the business Is legal or that It is in compliance with ;hate or local laws and regulations, Mailing Address: TYCO INTEGRATED SECURITY LLC AT TN: LICENSING DEPT PD BOX 3042 BOCA RATON, FL 33431 -0942 2012 .2013 ReceiPt #10h -11- 00000:157 Paid 09/05/2012 165.0) p.1 c I r t • TAXC©Li� !1 14��� 6�Imma TAX 11lCEIPt 2113. •'�c � `. COUIRY- ETAT! OF RI.ORIFLA :;► FAST -wSS U.S. FOSTAUE ELAO}.ltsA oil � =1111111116 SEAT. 30. 3018 ;s•'. PAID FL �W.. 14 Q 1d1AI Fi. X9130 low M$kAVW AT PL.AOE Of W11=38 1 � lY CQDE LLLAPii td/k• ARC 9.D MIAMI, PERMIT M06 291 . ::' TliiS IS NOT A BILL — DO MOT PAY 368733'3 RENEWAL s BUSINESS MWE1 LOCATION RECEIPT NO. 3815201-01 TYCO INTEGRATED SECURITY LLC DOING BUS iN DAD£ CO ! OWfMFk i TYCO INTEGRATED SECURITY LLC See. TVs of Business I 2t1�7�SECURITY SYSTEMS MONITORING I EU9NEas TAx RECCIPr. R INES ROr PERw 1818 IMLCea m 71•3EUre My 'Err7i61N0 AEep1.AlORY 4R }2G,E,OA uas ap . DO1�07FOR'NARD *Mw OR MIUS. WR *oils it etw" rRe Aar *Ei,Rw�,aRru Tim TYCO INTEGRATED SECURITY LLC PEA UR `ER's ! i RR lAi- is ATTN LICENSING DEPT riowEDu um .TM OMr GFJJuE FXf, P 0 BOX 3042 BOCA RATON FL 33431 PAV.wff RECEMED ru C IL[C�,CRB! 08/07/2012 60120000533 000250.00 I�.li „�IL�L,hIlu�. 1111 „hlnhil��lilf�,�84�1,Id SEE OTHER SIDE r t • CERTIFICATE. OF LIABILITY INSURANCE °AIM` 11I19/2012 9t2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CE=RTIFICATE 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 ce, 8181 o holder is an ADDITIONAL INSURED, the palicy(les) must be endorsed. N SUBROGATION IS WAIVED, Subject W the terms and conditions of the policy, certain policies may require an ondorsentetlt. A statetttetlt on this cartiRcato doves not confor rights to the eertificide holder In lieu of such endorsement(s). PRODUCER N8QIEAGT Bhavna Chauhan Marsh USA Inc. Nt:0; 1212) 345 - 87392) 948 -8852 1166 Avenue of the America$ E-MAIL I oRESS: P3.oase see bottom of and page _ New York. NY 10036 JNSUR15RISIAPPOSDING COVERAGE, NAIL _ INSURER A: Commerce & Industry Ins Co. 18410 INSURED INSURER e: Illinois National Insurance Co. 23817 INSURER C: Neff Union Fire Ins Co. of Pittsburgh, PA 19445 T Integrated Security LLC. tegra INSURER D: New Hampshire Ins. CO. 23541 10785 Way Miramar, FL 3307.5 United States COVERAGES CERTIFICATE NUMBER: 1077655 - A REVISION NUMBER: THIS 1S 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 BROWN MAY HAVE BEEN REDUCED BY PAID CLAIM$. IL R - AUD TYPO OR INSURANCE POLICY EPF QLICY BXP LIMS POLICY MBVR IT NIJ NWT D GENERAL LIABIUTY OIL 71$8417 (Primary GL) 9/28/2012 101112013 EACH OCCURREM09 8 $1,000.000.00 Dannn E T u PF)EEF�a ggru X • COMMERCIAL GfiNEJIFU. LIABILITY $ $1,000,000.00 CLAIMS-MADE O OCCUR MEDEXP(Arryanap rwtl) S S1D,000.00 OWNRWS S CONTRACTOR $ PROT PERSONAL & ADV INJURY S $1,000,000.00 ,. & $Z,OOO,t100.00 OENt RAL AGGREGATE, GUN% AGGROGATE LIMIT APPIJa3 PCR: -M PRODUCrF . COMP/OP AGG $ $2,000.000.00 X POLICY 2= I.00 $ C AUTOMOBILE LIABILTY CA 3447245 (AIL Other States) $128/2012 101112013 COMgiNi, S LE L MIT . Les aaeltlnntt $1.000,OQ0,00 C )( ANY AUTO CA 3447251 (MA) 9/2012012 101117.013 BODILY INJURY (Pnr peron) S C p ALL OWNED sGHBOULED AUTOS AUTOS CA 3447254 (VA) CA 3447352 (NH) (Primary AL) 2/2 O12 8I2812D12 10/112019 10/1/2013 BODILY INJURY (Par AcrJdenq S _- _ 5 NON47WNED %( FROPCR�TY AMAM MIRED AUTO$ Ayes � � y S250.000. 00 Nrw mwpsmia tcsL) UMBRELLALWS EAC1I2CCURRENCR. S _ $ EXCESS I" CLAIMS -MADE AGGREGATE PRODUCTS- A vvudelct:Ia� �uwrensnllun are, wer.v ou tr�� 9!2812012 70/t12013 A OtiY +S I . I' B AND rpaPLOYBRS' unlallm YIN WC a434e4a►a 1MI) 9/28/2012 10/1/2019 ANY PROPFURTORMARTNERIEXECUTIVE WC 0434648$2 (CA) EL. EACH AGCIDfiNT 6 C ORFiCERIAEMSER EXCLUDED? � NIA WC 04SWOO1 (AK Other States) 9/28/2012 1101112013 D (Mandatory In NH) 9!2812012 IWII2013 CJ.. OISE!15E - EA EMPLOYE S wC 043484673 9/Zttl2o (MN) 12 1oi1rz013 D InEa�',i e. u. E.L_ DIRPAAF . POLICY LIMIT DESCRIPTION OF OPERATIONS I I.00AYIONS I VEHICLES (Attw* ACORIJ IM. Addltloael RQMAraa Sch0d^ It mom 50404Is nxryuod) Please refor• to attached ACORD 101 for further remarks. Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd Ave. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Miami Shores, FL 33138 ACCORDANCE WITH THE POLICY PROVISIONS. United Slates AUTHOAW REPRESF_NTATME n+nit'.ia UB/t ING.O'/ c mhh Klm. Caalal P 01988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 4 STATE OF FLORIDA DEPARTVJ= OF BUSY. ss AND PROPESSIONKL RSGULA.TION ELECTRICAL CONTRACTORS LICENSING 330ARi3 (8 5 0) 487-1395 1940 NORTH XON103 STREET 4 TALLAHASSEE FL 32399 -0783 ZACURY, DAVID J TYCO xNTEGRATE+.D SECURITY LLC 8o BOX 3042 LICENSING DEPT BOCA R,AT'ON FL 33481 ':•N "•' :, °w.�,�'�`%4TE.O�F •• 11 ;'' ^r' ;.:.:••r✓:�"4:at S•� .. ,•."iJ•.l. ;�fl Congratulationsl With this license you become one of the rrear}y one mlttion p cE>51 Business a Professbnai R u#ation. Floridians licensed by. the Departmen# of t3usin and eg r. Our professionals and businesses range from architects to yacht brokers, from :. ;;s ,, ,,�;, ,,�• ^y: ' , °v '!•.: t.:. <..; boxers to barb ue restaurants and they keep a's economy strong. e4 Flo EF000047 ��,ti r�� °j , 2 .1- 28063467• Every day we work to improve the way we do business In order to serve you bette For Information about our services, please log onto www.my(loedelicanse.com A There you can find more information about our divisions and the regulations that ,'"` HFL3 '.'' g1 �'`� '; ''�''�3.•., :., .; . „r t #ntpact you, subscribe to department newsletters and team more alscul the �.. "!O'{ NA Ue ortmant s Initiatives. a• rr • : ax '': ;` Our mission at the Department Is:• License ffflclentiy, Regulate Fairly. We � ^ '^ "' ,•: . . constantly strive to servo you better so that you aan serve your customers.' ai¢ xrxlt�in "1ri;�.:ts 'mien, aA, `' c}! :49 Na•:'.s Thank you for doing business in Florida, and congratulations on your new IIcEr{sel ': ";: •a�.y.,.�., ,"o a, sa °y,- DETACH HERE i i 2 t l:y : ! e