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EL-14-1792Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-220207 Scheduled Inspection Date: September 25, 2014 Inspector: Devaney, Michael Owner: ADAM SHEPARD, ALISON ANTROBUS Job Address: 295 NE 95 Street Miami Shores, FL 33138 - Project: <NONE> Contractor: HOME ENTERTAINMENT DESIGN SOUTH, INC. auilding Department comments PREWIRE AND INSTALLATION OF 2 TV'S AND 4 SPEAKERS. ALSO PREWIRE FOR FUTURE SPEAKER. Permit Number: EL -8-14-1792 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Low Voltage Phone Number Parcel Number INSPECTOR COMMENTS False Inspector Comments Passed Ef— Failed �.'oe /�4 Correction ❑ Needed Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. 1132060133970 Phone: (954)929-2700 September 24, 2014 For Inspections please call: (305)762-4949 Page 33 of 34 BUILDING PERMIT APPLICATION ❑BUILDING ❑ PLUMBING dELECTRIC vor +"t ❑ MECHANICAL Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (30S) 762-4949 FBC 20kb Master Permit No. 13 Z ri 9 5 Sub Permit No. E- 14, 1901 ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL [:]PUBLIC WORKS CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: *2q!5 NP q5 5 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: Ell -Natrie Fee Simple Titleholder): SOW f i0 �� Phone#: „ �_ A Address: a" 5 M -E , 5 57 City: AA 1 o rej State: PL— Zip: Tenant/Lessee Name: Email: CONTRACTOR: Company Name: L Alef{lr.rne(* n Phone#: a5q-?Zt? Z2G0 Address: Z110 i�/�«`r1 64— City: _ RollL4W— W6 --t___6 State: L Zip: 350zo Qualifier Name: %cC�VL°i Phone#: ?.5Ug—yioa er State�ertiftcati.sm or_Beglst[a F.S J1 DOD J!31 Certificate of Competency#: DESIGNER: Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit: $ ( OCD • DO Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration 12 New ❑ Repair/Replace ❑ Demolition Description of Work: ?t%rw i' P. 0j'6 C'ytC \ [y'F iz� lV 'S cam. LLQ 5DE4 Kers s we wl�\ !�14v "'L -L- Ezr c-Uw-e oy" Specify color of color thru tile: 013 Submittal Fee $ Permit Fee $ 146 Ve.> CCF $ CO/CC $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) DBPR $ Notary Double Fee $ Bond $ TOTAL FEE NOW DUE $ 0 Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, 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 reinspecti9n fee will be charged. T -e fq ,eM i"g instr ment was acknowledged before m this `r da 20 by IF ho is ersonally k wn to me or who has produced as identification and who did take an oath. NOTARY PUBLIC• Print: dJ.MVWW1W Tstafyr run euase yr rionaa . • My Comm. Expires Feb 21, 2016 Seal:="�o;cc Commission # EE 171770 Bonded Through National Notary Assn. The for` pg' ®in �{ day o me or who has produced identification and NOTARY PUBLI Sign: Print• 1C`� Seal: . was acknowledged before a this by who oath. FERNANDEZ ---y rump, - oiatu Ur riurlua My Comm. Expires Feb 21, 2016 Commission # EE 171770 Bonded Through National Notary Assn. to as �7 1 APPROVED BY�� -°lU-% Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) r3m.t.,. 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'V' y h r ��Cj�Iftl�,',p+�.t7� Tri!aB7VrLY' ...;r. ,!".`.t ”✓: ;,. ?LT•V 'Y ;Litt.��ii!♦ ":'�' "d {ri•'�.• d r '""y:� d + " ,,. 4'y"•^5{ iAf '0'j :.B3S4:L�:L'ii�i po HOMEEN1 OP ID: NCOL OF LIABILITY INSURANCE DATECERTIFICATE 108/14/2014 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 this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Tanenbaum Herber of Florida 2900 SW 149th Avenue Miramar, FL 33027-6605 Efrain Jove CONTACT NAME: A No Ext): Nc No E-MAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC / 08/30/2013 INSURER A: FCCI Commercial Ins. Co. 33472 EACH OCCURRENCE $ 1,000,00 INSURED Home Ent Design South Inc dba HED South INSURER 8: National Trust Ins. Co. 20141 PERSONAL BADV INJURY $ 1,000,00 2010 Thomas Street INSURER C: INSURER D: Hollywood, FL 33020 INSURER E: $ INSURER F: AUTOMOBILE COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THEJNSURED 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 POLICIEy4. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE POLICYNUMBER POLICY EFF MMlDD POLICY EXP MM/DO LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR '/+A-;-'jk CPP00076266 08/30/2013 08/30/2014 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,00 PERSONAL BADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS Ee adeMSINGLE LIMIT $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ PER ACCIDENT) B X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE UMB00075096 08/30/2013 08/30/2014 EACH OCCURRENCE $ 2,000,00 AGGREGATE $ 2,000,00 DED I X I RETENTION $ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? F7 (Mandatory in NH) Use, describe under DESCRIPTION OF OPERATIONS below N / A WC STATU- OTH- LIMITS E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Contractor license number: ES12000837 CERTIFICATE HOLDER CANCELLATION MIAMSH2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MIAMI SHORES VILLAGE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 10050 N.E. 2ND AVE. ACCORDANCE WITH THE POLICY PROVISIONS. MIAMI, FL 33138 AUTHORIZED REPRESENTATIVE '/+A-;-'jk ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ASC hr CERTIFICATE OF LIABILITY INSURANCE `...� DATE(MM/DDIYYYY) 08/1412014 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 this certificate does not confer rights to the certificate holder in Ilau of such endorsement(s). PRODUCER Marsh USA, Inc, 3031 N. Rocky Point Drive West, Suite 700 CONTACT NAME: PHONE FAX No): Tampa, FL 33607 Attn: Tampa.CertRequest@marsh.com I F:212-948-0529 E-MAIL ADDRESS: INSURE S AFFORDING COVERAGE NAIC # INSURER A : Illinois National Insurance Company 23817 342881-FL-WG14-15 117141 INSURED DecisionHR, Inc. INSURER B: GENERAL AGGREGATE $ 11101 Roosevelt Blvd N INSURER C: INSURER 0: St Petersburg, FL 33716 INSURER E: LIABILITY ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS INSURER F: COVERAGES CERTIFICATE NUMBER: ATL -003292458-02 REVISION NUMBER -4 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. SR ILTRR TYPE OF INSURANCE ADDL BR POLICYNUMBER POLICY EFF MMND EXP LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE r_1 OCCUR EACH OCCURRENCE $ DAMAGE T RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LI O- APPLIES PER: POLICY JECI F-1 PRO LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea ac.ident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR/PARTNEWEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory In NH) Ii yea, describe under DESCRIPTION OF OPERATIONS below N I A WC 028329029 06/01/2014 06/01/2015 X I WC STATU- OTH- FR E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L.DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space is required) Re: License Number- ES12000837 Coverage Is provided for only those employees leased to but not subcontractors of Home Entertainment Design South, Inc. 17 i .111 A L4L1 1 -2. M X1910 Miami Shores Village 10050 NE 2 Ave Miami Shores Mllage, 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 of Marsh USA Ina Kim Arvanitis @ 1988-2010 ACORD CORPORATION_ All rinhtc rraawrvdar1 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD