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EL-14-2721 �r Miami Shores Village DEC 122014 Building Department 31_"I _. 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC�20 BUILDING Master Permit No. � PERMIT APPLICATION Sub Permit No. ❑BUILDING ire�LECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 41,e5; '24^k/ AfI147 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): �4 S . I—� Phone#: /.�/�3�-& Address: Q O ne- "1 S S-I-ree_+ City: WA-Af SkOre-S State: �FL-Oit,I 'e, Zip: 15.3 ve Tenant/Lessee Name: X/M,4L F)7- `M 1A-1-0 My1c_. Phone#:&®✓C- 9.5 4b 4 Email: f7Ltr2Sc� CONTRACTOR: Company Name: �� lam. Phone#: Y5 ® Address: 757 9 ry City: ' State::: Zip:,Z?Wl/` Qualifier Name: AWTHe-velPhone#: g' State Certification or Registration#: / ®®®V k-7 Certificate of Competency#: DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration Ki ew ❑ Repair/Replace ❑ Demolition Description of Work: 13X--(e '11� —( -o — Specify color of color thru tile: Submittal Fee$ Permit Fee$ ZgPl/' r&,00 fJ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature \� Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this l L day of e,,0-"404F .20 by y day of b0-1-O/-I&O1e ,20 by who is personally known to ill'T1" 40o V ,who is personally known to me or who has produced 41 e-,&"-S as me or who has produced it–e ee 4 S g as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: ,r Sign: Sign: Print: Print: ;oar ar" AI=ANGULOSeal: := ',' AILLEN R.ANGULO Seal: ' . ^ Notary Florida*� ,cNotary Public-State of FloridaoMy Com ,2014,, .aQ My Comm.Expires Dec 19;2014 ; F11% o� Com26 �•i'E Opp oFF% Commission#EE 49926; """'� " oe�. a,uuu` APPROVED BY `Z I&Oez- Plans Examiner Zoning � Structural Review Clerk (Revised02/24/2014) STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ELECTRICAL CONTRACTORS LICENSING BOARD {850}487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 CLARKS,ANTHONYALPHANSO SECURITYALARM DMSON LLC 600 NE 193RD STREET MIAMI-DADE FL 33179 Congratula&ms! With thss Gcmm you become one of the nearly ----- --- am million Fbrkkm Ocerrsed by the Deparhmerd of Business and Pmfesslonal Regulation. our profimronals and busirmsesrang® STATS Ofi FLORIDA from archbcts to yacht brokers,from boxers to barbeque�, p SINES$AND and they keep FlorWs economy strong. ULA7'fON r Every day we work to Improve the way we do business kr order to X200001379 F 8/9:0/2b14 serve you better: For k9briraion about our services.please log ontowww- - - rifthmnsexam. There you can&W more wannaffon CtMT about ouodivisforrs and thefeqLdedons#W knpact you,subscribeMARKEl gnt mars am more about the Depwknmrs - �st - Our nussion at the Deprbnwd is:License Effidently,Regulate Fairly. f We ConslamIy strive to serve better so that you carr serve your Thardc you for dbu� s fi Fes, Customers. iS CERTLFtED under the pmvlsions of t;h 489 fS and congon your new license! oa 2M6r;amt ez~ DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON,SECRETARY DEP RTA�ENT E ,SAND 1'Rt�FES$ NAL RE ULAMON i �. - -� fes' �R�t�C�E�►I_StN��BOA�tD - r , �" $o �Fit3-�QI�AtL �-�Ja�INES� y BION " P. I,Jl7deF fllNev.NJ y SE WM 21, 103 . c t- �� V'UY/ -+� ' - l 9 .. __. '•"" a;, 3a tai, r. .yle - • t .�.-^ �` �,�� t e`� y .fi .d 3.� 5.- � b - � k t y E � 4'} • • ■ t Lscr1141- OrMM4 DISPLAYAS REQUIRED BY LAW s[-Q# L14Mowm182 04-16-2014 JEFF ATWATER STATE OF FLORIDA CHIEF FINANCIAL OFFICER DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS' COMPENSATION CERTIFICATE OF ELECTION TO' BE EXEMPT FROM FLORIDA-WORKERS COMPENSATION LAW CONSTRUCTION INDUSTRY EXEMPTION This certifies that the individual listed below has elected to be exempt from Florida Workers' Compensation law. EFFECTIVE DATE: - 06/04/2014 EXPIRATION DATE: 06/03/2016 PERSON: CLARKE ANTHONY FEIN: 270440708 BUSINESS NAME AND ADDRESS: SECURITY ALARM DIVISION LLC 4425 MAHOGANY RIDGE DR. WESTON FL 33331 SCOPES OF BUSINESS OR TRADE: 1- 13URGLAR AND FIRE ALARM INSTALL IMPORTANT: Pursuant to chapter 440 . 06(14), F.S., an officer of a corporation who elects exemption from this chapter by filing a certificate of election under this section may not recover benefits or compensation under this chapter. Pursuant to Chapter 440.06(12), F.S., Certificates of election to be exempt... apply only within the scopeof the business or trade,listed on the notice of election to be exempt. Pursuant to Chapter 440.05(13), F.S.. Notices of election to be exempt and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shell revoker a certificate at say time for faflare of the person named an the certificate to meet the requirements of this section. DWC-252 CERTIFICATE OF ELECTION TO 8E EXEMPT REVISED 01-11 QUESTIONS? (850) 413-1609 PLEASE CUT OUT THE CARD BELOW AND RETAIN FOR FUTURE REFERENCE STATE OF FLORIDA IMPORTANT DEPARTMENT OF FINANCIAL SERVICES DIVISION OF WORKERS'COMPENSATION F Pursuant to Chapter 440.05114), F.S., an officer of a corporation who CONSTRUCTION INDUSTRY 0 elects exemption from this chapter by filing a certificate of election CERTIFICATE OF ELECTION TO BE EXEMPT FROM FLORIDAo L under this section may not recover benefits or compensation under this WORKERS'COMPENSATION LAW �-� D chapter. EFFECTIVE 06/04/2014 EXPIRATION DATE: 06/03/2016 Pursuant to Chapter 440.05(12), F.S., Certificates of election to be PERSON ANTHONY CLARKE H exempt_ apply only within the scope of the business or trade listed on FEiN 270440708 R the notice of election to be exempt BUSINESS NAME AND ADDRESS: E Pursuant to Chapter 440.05113), F.S., Notices of election to be exempt 4425 4425 Mr ALARM DIVISION RIDGE GE DR LLC and certificates of election to be exempt shall be subject to revocation if, at any time after the filing of the notice or the issuance of the . .WESTON, FL 33331 certificate, the person named on the notice or certificate no longer meets the requirements of this section for issuance of a certificate. The department shall revoke a certificate at any time for failure of the SCOPE OF BUSINESS OR TRADE person named on the certificate to meet the requiremeitts of this 1- WRGLAR AND FIRE ALARM INSTALL section. QUESTIONS? {8501 413-1609 CUT HERE Carry bottom portion on the job, keep upper portion for your records. DWC-252 CERTIFICATE OF ELECTION TO BE EXEMPT REVISED 01-11 115 S.Andrews Ave., Rm.A-100, Ft. Lauderdale, FL 33301-1895—954-831-4000 VALID OCTOBER 1,2014 THROUGH SEPTEMBER 30,2015 DBA: Receipt#:3 77-1593 9 SECURITY ALARM DIVISION LLC OFFICE/SALES/BUSINESS/ADMIN Business Name: Business Type: OFFICE/SALES) Owner Name:ANTHONY MAR.AGH Business Opened:07/07/2009 j Business Location:4425 MAHOGANY RIDGE DR ,a StatefCounty/Cert/Reg: WESTON Exemption Code: 4 Business Phone: a Rooms Seats Employees Machines Professionals Forvending Business only Number of Machines: Vending Type: v* Tax Amount Transfer Fee NSF Fee Penally, Prior Years _ Collecdion Cost Total Paid 45.00 0.00 000 0..00 0.00 0.00 45.00 44f �t THIS RECEIPT MUST BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS THIS BECOMES A TAX RECEIPT This tax is levied for the privilege of doing business within Broward County and is non-regulatory in nature.You must meet all County and/or Municipality planning WHEN VALIDATED and zoning requirements. This Business Tax Receipt must be transferred when the business is sold, business name has ganged or you have moved the business location.This receipt does not indicate that the business is legal or that it is in compliance with State or local taws and regulations. Mailing Address: ANTHONY MGH Receipt #01A-13-00005081 4425 MAHOGANY RIDGE DR Paid 07/03/2014 45.00 WESTON, FL 33331 �r a ; r 2014 - 2015 CERTIFICATE OF LIABILITY INSURANCEDATE@M/DDIYYYY) 1211212014 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND NOAPI Group HOLDER. TTH SONFERS GHTS CERTIFICATE THE OTO AM ND,CERTIFICATE EXTEND OR P.O.Box 934125 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Margate FL 33093 INSURERS AFFORDING COVERAGE NAIC# INSURED SECURITY ALARM DIVISION LLC INSURER A SC_O_TT_S_D_ALE INS CO 4425 MAHOGANY RIDGE DR INSURER B.__ -- WESTON,FL.33331 I-INSURER c INSURER D: INSURER COVERAGES THEPOUCIESOF INSURANCELISTEDBELOW HAVEBEEN ISSUEDTOTHEINSURED NAMEDABOVEFORTHEPOLICYPERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAYPERTAIN,THE INSURANCEAFFORDEDBYTHE POLICIESDESCRIBEDHEREINISSUBJECTTOALL THETERMS,EXCLUSIONS ANDCONDITIONSOFSUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY NUMBER :POLICY EFFECTIVE POLICLTR TYPF!OF INAURANCF Y EXPIRATK)N LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000.00 _ DAMAGE TO RENTED A X 'COMMERCIAL GENERAL LIABILITY i CPS2106286 i 10131/2014 10/31/2015 g(FA oeeurenoal_. :,$100,008.00 i` CLAIMS MADE i A I OCCUR: MEG W(Any one person) $5, .00 PERSONAL&ADV INJURY i$1,000,800.00 _ GENERAL AGGREGATE $;,000'000._00_ _GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMPIOP AG_G` $1,000,000.00 X POLICY LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) I � ALL OWNED AUTOS I BODILY INJURY SCHEDULED AUTOS (Per person) $ HIREDAUTOS J BODILY INJURY $ i NON-OWNED AUTOS (Per ecGderttj .- -- -----.------.---.-- PROPERTY DAMAGE !$ (Peraccdent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ($ _ ANY AUTO OTHER THAN _EAACC AUTO ONLY: AGO•$ EXCESS I UMBRELLA LUU3ILITY I EACH OCCURRENCE _•._:$ „ OCCUR CLAIMS MADE AGGREGATE _ $ j— .—. -- ----'-- - I$ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILI Y - .LWTSr R ANY PROPRIETORMARTNERIEXECUTNEYa E.L.EACH ACCIDENT $_- OFFICERIMEMSER EXCLUDED (MarkWoty in NMI E_L.DISEASE-EA EMPLOYEE $ If yes. 10-w det - 11_---- SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ALARM,SECURITY CAMERA,DATA&INTERNET INSTALLATIONS BLANKET ADDITIONAL INSURED APPLIES WHEN REQUIRED BY WRITTEN CONTRACT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION VILLAGE OF MIAMI SHORES DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 10050 NE 2ND AVENUE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABII F ANY KIND UPON THE INSURER ITS AGENTS OR MIAMI SHORES,FL 33138 REPRESENTATIVE AUT DRE SENT i ACORD 25(2009101) ©1988.2009 ACORD CORPORATION. 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