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EL-15-1085 OF en° s Miami Shores Village � 1f#�t �@ +r ' 4040 ti 10050 N.E.2nd Avenue NE4 V, Miami Shores,FL 33138-0000 � � Phone: (305)795-2204 ROVi5b lssuatI81p .,, Expiration: 11/0412015 Project Address Parcel Number Applicant 1066 NE 94 Street 1132050120120 STEPHEN MARINO Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone Cell STEPHEN MARINO 1249 NE 97 ST 305-812-0629 Miami Shores FL 33138 Contractor(s) Phone Cell Phone Valuation: $ 5,650.00 DELTA ALARM SYSTEMS, INC (305)223-7520 Total Sq Feet: 0 Type of Work:LOW VOLTAGE CAMERAS,ALARMS SYSTEM Available Inspections: Additional Info:LOW VOLTAGE CAMERAS,ALARMS SYSTEM Inspection Type: Classification:Residential Review Electrical Scanning:1 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $3.60 Invoice# EL-5-15-55461 DBPR Fee $3.38 DCA Fee $3.38 05/08/2015 Credit Card $ 194.36 $50.00 Education Surcharge $1.20 05/06/2015 Credit Card $50.00 $0.00 Permit Fee-Additions/Alterations $225.00 Scanning Fee $3.00 Technology Fee $4.80 Total: $244.36 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS 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. Futhermore,I authorize the above-named contractor to do the work stated. May 08, 2015 Authorized Signature:Owner / Applicant on ract / Agent Date Building Department Co May 08,2015 1 ' • Miami Shores Village REc� � MAY �6 2015 Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 B� Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 2010 BUILDING Master Permit No. 9 C- 5 S 4S PERMIT APPLICATION Sub Permit No. IS4d 35 ❑BUILDING 0 ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL DPLIBLICWORKS CHANGE OF CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1066 N.E. 94 ST. 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: OWNER:Name(Fee Simple Titleholder):STEPHEN MARINO Phone#: Address:124_9 N.E. 97 ST. city: MIAMI SHORES State: FLZip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: DELTA ALARMS SYSTEMS Phone#: 305-223-7520 Address: 13350 S.W. 131 ST. City. MIAMI State: FL Zip: 33186 Qualifier Name: JOSE QUINTERO Phone#: 305-223-7520 State Certification or Registration M E)/ ®06 U %®I Certificate of Competency#: 1-9-0 00 t DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ O� Square/Linea r,Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: LOW VOLTAGE CAMERAS, ALARM SYSTEM WIRELESS Specify colon-off colorr thru tile: Submittal Fee$by '0 w Permit Fee$ ���®® CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ G /— TOTAL FEE NOW DUE$ '—l Lf 3(0 (Revised02/24/2014) d 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 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 reinspection fee will be charged. q�-� Signature SignaAregoinginstr OWNER or AGENT CNTRACTOR The foregoing instrument was acknowledged before me this The fent was acknowledged before me this day of P? 11 ,20 6# by / 73 day of -p-Prod I L 20 /,SQ by 7,zy 9, At 2 c v d ,who is personally known to BJ®Se oj,X72 e U who is personally known to me or who has produced as Mg or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: t Si s IoriAa t Print: x Print: CofumbIft°••' Commissi N FF 11765 ••'• �° Ilya Seal: Bonded Through National Nc.,y Assn. Seal: """ �. ************************************************************************************************************ APPROVED BY �'jL 6iV� y Plans Examiner Zoning Structural Review Clerk (Revised02/24/2014) AC40R"® CERTIFICATE OF LIABILITY INSURANCE DATE 516/201(MMIDDYYYY) 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). ONTACT PRODUCER John T. Costa Agency, Inc. NAME: Ralph A.Costa P.O. Box 2338 PHONE 973-835-8444 FFA—, No: 973 835 3056 2025 Hamburg TPKE Suite J E-MAIL Wayne, NJ OT470 ADDRESS; ral h bur Iaralarminsurance.com INSURER($)AFFORDING COVERAGE NAIC B www.burglaralarminsurance.com INSURER A: Scottsdale Insurance INSURED INSURER B: Delta Alarm Systems Inc 13350 South West 1�1st Street, Suite 101 INSURER C: Miami FL 33186 1 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 24572909 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. ILTR TYPE OF INSURANCE POLICY NUMBER MMID F MMM/DCY EXP LIMITS A `/ COMMERCIAL GENERAL LIABILITY 4061417 4/25/2015 4/25/2016 EACH OCCURRENCE $ 1,000,000 CLAIM8 MADE REMISE OCCUR PS Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY ✓❑JECT E LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: I$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accideirt UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION I PER H- AND EMPLOYERS'LIABILITY Y STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTNE /N OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ A Errors&Omissions 4061417 4/25/2015 4/25/2016 $1,000,000 Each Claim $3,000,000 Aggregate DESCRIPTION OF OPERATIONS/LOCA71ONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached H more space Is required) NO ADDITIONAL INSURED COVERAGE PROVIDED EY0000101 CERTIFICATE HOLDER CANCELLATION Ci of Miami Shores Village SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City o NE 2 i Shore g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores Village FL 33138 AUTHORIZED REPRESENTATIVE Ralph A.Costa ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CER')'NO.: 245572P09 Delta Alarm Systeme,Tnc 5/6/2015 8:44:38 AA) (EDT) Page 1 of 1 This certificate cancels and supersedes ALL previously issued certificates.